PJC General Negligence 2024

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

PJC 25.7

Answer “Yes” or “No.” Answer: _______________ If you answered “Yes” to Question ______, then answer the following ques tion. Otherwise, do not answer the following question. QUESTION ______ Does the permanent major neurocognitive disorder found by you in answer to the preceding question— 1. require occasional supervision of Paul Payne in the performance of routine daily tasks of self-care, and 2. render Paul Payne permanently unemployable? Answer “Yes” or “No.” Answer: _______________ PJC 25.7B Physically Traumatic Injury to the Brain—Questions— When Carrier Appeals QUESTION ______ Was Paul Payne ’s physically traumatic injury to the brain not a producing cause of a permanent major neurocognitive disorder beginning on [ date ]? [Insert PJC 25.1A definition of “producing cause.”] Answer “Yes” or “No.” Answer: _______________ If you answered “No” to Question ______, then answer the following ques tion. Otherwise, do not answer the following question. QUESTION ______ Does the permanent major neurocognitive disorder found by you in answer to the preceding question— 1. not require occasional supervision of Paul Payne in the perfor mance of routine daily tasks of self-care, and 2. not render Paul Payne permanently unemployable?

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