PJC General Negligence 2024

PJC 25.7

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

PJC 25.7A TBI—Incurable Insanity or Imbecility—Question— When Claimant Appeals QUESTION ______ Did Paul Payne sustain a compensable 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: _______________ PJC 25.7B TBI—Incurable Insanity or Imbecility—Question— When Carrier Appeals QUESTION ______ Did Paul Payne not sustain a compensable 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, 2023.] PJC 25.7A Physically Traumatic Injury to the Brain—Questions— When Claimant Appeals QUESTION ______ Was Paul Payne ’s physically traumatic injury to the brain a producing cause of a permanent major neurocognitive disorder beginning on [ date ]? [Insert PJC 25.1A definition of “producing cause.”]

368