Changes to the Catastrophic Impairment Definition

• Jeremy Diamond
• Categories: Media
• May 3, 2016

As of June 1, 2016, the definition of catastrophic impairment will undergo significant changes.

Below are some of these changes:

Reduction in Benefit Entitlements:

• Medical Rehabilitation and Attendant Care Limits will be combined in the total amount of $1,000,000.00 instead of $1,000,000.00 each.

Brain Injury

• If older than 18:
  • (a) must show positive findings of intracranial pathology on medically recognized brain diagnostic technology; and o
  • (b) GOS-EGOS testing results in:
    • (i) vegetative state 1 month or more after accident;
    • (ii) upper or lower severe disability 6 months or more after accident; or
    • (iii) lower moderate disability 1year or more after accident.
• If younger than 18:
  • (a) accepted for inpatient admission to public hospital, showing positive findings on medically recognized brain diagnostic technology; or
  • (b) accepted for inpatient admission to neurologic rehab in pediatric rehab facility; or
  • (c) 1 month after accident, is King’s Outcome Scale for Childhood Head Injury category 2 (vegetative); or
  • (d) 6 months after accident, is King’s Outcome Scale for Childhood Head Injury category 3 (severe); or
  • (e) 9 months after accident, function is seriously impaired, so not age-appropriately independent and requires supervision or assistance for a majority of the day.

Whole Person Impairment Survives but Modified

• AMA Guides 6th edition not 4th edition
• WPI can be determined at two years after the accident or if physician states in writing 3 months or more after accident that impairments which meet or exceed 55% WPI are unlikely to improve to less than 55%.

Paraplegia / TetraplegiaParaplegia or tetraplegia must be a permanent grade on the ASIA Impairment Scale of A, B, C or DAmputationUpper Body – amputation of a single arm or leg is considered catastrophic.Lower Body – amputation of a leg is only catastrophic if it is through tibia or higher, or a severe and permanent leg structure altering function causing Spinal Cord Independence Measure score applied on even indoor surface over 10 metres to be 0 to 5.

Visual Acuity = CAT if…

• Visual acuity in both eyes is 20/200 or less after correction.

Number of Marked Impairments Required

• If one only has mental/behavioural impairments, and an assessment using the AMA Guidelines 4th edition results in a Class 4 marked impairment in 3 or more areas of function or 1 Class 5 extreme impairment that precludes useful functioning due to mental or behavioural disorder”.
  • This can be determined at two years after the accident or if physician states in writing that the impairment is unlikely to improve to less than 3 Class 4 marked impairments in areas of function that preclude useful functioning.

These above changes are significant in how catastrophic impairments will be determined after June 1, 2016 and will ultimately result in the further erosion of benefits for those who have been the most seriously injured in motor vehicle accidents in Ontario.