PJC General Negligence 2024

W ORKERS ’ C OMPENSATION —L IFETIME I NCOME B ENEFITS

PJC 25.7

PJC 25.7

Skull/Traumatic Brain Injury—Questions

[Use the following for a claim for workers’ compensation benefits based on a compensable injury that occurred before September 1, 1997.]

PJC 25.7A Skull—Incurable Insanity or Imbecility—Question— When Claimant Appeals

QUESTION ______

Did Paul Payne suffer a physically traumatic injury to the brain that is a pro ducing cause of incurable insanity or imbecility?

[Insert PJC 25.1A definition of “producing cause.”]

Answer “Yes” or “No.” Answer: _______________

PJC 25.7B Skull—Incurable Insanity or Imbecility—Question— When Carrier Appeals

QUESTION ______

Did Paul Payne not suffer a physically traumatic injury to the brain that is a producing cause of incurable insanity or imbecility?

[Insert PJC 25.1A definition of “producing cause.”]

Answer “Yes” or “No.” Answer: _______________

[Use the following for a claim for workers’ compensation benefits based on a compensable injury that occurred on or after September 1, 1997, but before September 1, 2023.]

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