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Proposed Changes to the “Catastrophic Impairment” Definition

In December 2011, the Financial Services Regulatory Authority of Ontario released the Superintendent’s Report on the Definition of Catastrophic Impairment in the Statutory Accident Benefits Schedule, which provides a host of recommendations for amendments to the current definition of “catastrophic impairment,” or CAT.

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Suggested Amendments to the CAT Definition

Some argue that the current definition of catastrophic impairment, found in the Statutory Accident Benefits Schedule (SABS), is somewhat limited and unclear.

The Superintendent’s report provides numerous suggestions for clarifying each subsection of SABS’s definition:

  • Paraplegia/Tetraplegia – Patients should not be required to complete inpatient spinal cord injury rehabilitation in a public rehabilitation hospital, given that their condition cannot and will not improve, which is contrary to the Expert Panel recommendation.
  • Severe walking difficulties – One of the suggestions was that claimants with below-knee or higher amputation of one leg should be deemed to have a catastrophic impairment.
  • Traumatic Brain Injury in Adults – the report agrees with elimination of Glasgow Coma Scale in favor of the Extended Glasgow Outcome Scale and recommends the timeline in which claimants are evaluated should be modified as follows: “injuries resulting in a Vegetative State would qualify one month after the accident; injuries classed as Upper or Lower Severe disabilities would qualify at six months; and injuries classed as Lower Moderate disabilities would qualify at one year.”
  • Pain – Pain should not qualify as a separate impairment when making determinations.
  • Psychiatric Impairment – Although the combined effect of certain conditions can be taken into consideration when making a catastrophic injury determination, a psychiatric and physical impairment should not be combined.
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Highlights of the Changes to the CAT Determinations

The Superintendent also made two very significant suggestions that will affect families across Ontario:

  • Children with brain trauma – The Superintendent suggested that children who suffer a brain injury and are admitted to a Level I trauma centre should be designated as catastrophic automatically, without need for assessment. This change will ease the burden on many families forced to wait for a CAT determination to have access to benefits.
  • Interim benefits – Claimants who clearly require intensive and prolonged rehabilitation should receive interim benefits while a final determination is sought. Interim benefits will provide patients with “access to the medical and rehabilitation services necessary to maximize their chances of achieving optimal recovery.” The Superintendent suggested a cap of $50,000 for interim benefits to avoid possible abuse of the system.

Changes in the CAT Definition May Affect Your Case

Changes in the definition of CAT are causing alarm in some patients and families currently holding a catastrophic injury designation and receiving accident benefits. Some future victims may find it more difficult to receive a CAT designation, while others will benefit greatly from the proposed changes.

“A determination of catastrophic impairment often makes a crucial difference to an accident victim’s recovery and quality of life,” points out Canadian Lawyer Magazine. As such, if you or your family member has sustained a catastrophic injury, you’ll want to discuss your case with a lawyer to determine what benefits might be available and how the proposed changes might affect your situation.

Call Preszler Injury Lawyers in Ontario for Assistance

Our caring, professional team at Preszler Injury Lawyers in Ontario is passionate about helping individuals and families obtain the benefits they deserve and need. To see how we may be of assistance to you, call us today at 1-800-JUSTICE® for a free, no-obligation consultation, or contact us online.

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