Factors Considered When Determining Catastrophic Impairment

When a victim is seriously injured in a motor vehicle accident, a determination will be made as to whether or not the victim has a “catastrophic impairment.” There are several clinical tools that physicians can use and factors to consider when making the determination, some of which are discussed below.

If a victim is determined catastrophically impaired, the amount of accident benefits to which he or she is entitled increases significantly.

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Defining Catastrophic Impairment

The definition of catastrophic impairment is found in the Statutory Accident Benefits Schedule (SABS), a regulation under the Insurance Act. It’s a complicated piece of legislation, which many professionals in the legal and medical field find far too discretionary and inadequate.

The SABS explains that a catastrophic impairment includes the following:

paraplegia or quadriplegia;
the amputation of a limb or another impairment that causes the total and permanent loss of a limb;
total loss of vision in both eyes;
a brain impairment that results in a score of nine or less on the Glasgow Coma Scale or a score of a two or three on the Glasgow Outcome Scale;
one that results in 55 percent or more impairment of the whole person; or
a class four or five impairment due to mental or behavioural disorders.

New Recommendations for Assessing Levels of Impairment

The Ontario Superintendent’s Report on the Definition of Catastrophic Impairment in the Statutory Accident Benefits Schedule supported an Expert Panel’s recommendations of four clinical tools used to measure the “accuracy, relevance, clarity, validity, reliability and predictive ability of catastrophic impairment determinations.”

These tools include:

American Spinal Injury Association (ASIA) classification for spinal cord injuries;
Extended Glasgow Outcome Scale (GOS-E) for traumatic brain injuries;
Spinal Cord Independence Measure for severe difficulty walking; and
Global Assessment of Function (GAF) for psychiatric disorders.

The Superintendent suggested that determinations for children with brain trauma be expedited and that claimants who unequivocally require intensive and prolonged rehabilitation should have access to interim benefits while determinations are finalized.

The Superintendent stated, “The Panel is of the opinion that the current system leads to inconsistent catastrophic impairment determinations and frequently gets the diagnosis wrong. The proposed changes would make the process more accurate, consistent and objective, and would also speed up determinations and reduce transaction costs and disputes.” Discuss the most recent assessment methods with your attorney.

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Additional Factors Considered

When determining whether or not a patient is catastrophically injured, the combination of impairments must be considered.

Impairments combined with other injuries that will be taken into consideration include:

multiple soft tissue injuries;
multiple orthopaedic injuries;
acquired brain injury;
dental injuries; and
psychological impairment.

Talk to your lawyer about whether your injuries will fit the catastrophic impairment definition.

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Preszler Law Attorneys in Ontario Can Help Obtain Benefits

Receiving a catastrophic impairment determination is an important part of the clam process because the victim’s cap on available accident benefits – including attendant care, medical and rehabilitation, and housekeeping and home maintenance – rises considerably.

Our accident lawyers at Preszler Law Firm in Ontario can help with your claim and ensure you and your family get the benefits to which you’re entitled. Call our firm at 1-800-JUSTICE® for a free consultation, or contact us online today.

Call or text (416) 364-2000 or complete a Free Case Evaluation form