Changes to Statutory Accident Benefits Schedule and Catastrophic Injury
Automobile insurance is constantly changing . It seems that the government continues to strip away at some of the most vital services required for injured people, especially those who are severely injured and need it most, those with a catastrophic injury. The new definition will apply to all accidents in Ontario on or after June 1, 2016. The Statutory Accident Benefits Schedule (“SABS”) provides accident benefits for people who are involved in a motor vehicle accident in Ontario. Regardless of whether or not they were at fault, or whether or not they were a driver, passenger or a pedestrian.
Definition of Catastrophic Injury Impairment
Many of the changes are in the area of Catastrophic Injuries. The most significant of the reductions in Accident Benefits are in the Medical and Rehabilitation and Attendant Care benefits for individuals with catastrophic and non-catastrophic injuries.
There are also new measures used to assess whether or not someone is deemed “catastrophic”.
1- Paraplegia or Tetraplegia
The two scales or measures that are the primary source for the catastrophic determination of spinal cord injuries are The ASIA -International Standards for Neurological Classification for Spinal Cord Injury as well as the SCIM Spinal Cord Independence Measure Version III. The definition of “catastrophic impairment” has been revised to reflect current medical studies.
2-Residual Neuro-Urological Impairment or Urological Impairment
3-Loss of vision in both eyes
4-Traumatic Brain Injury
When assessing whether or not a patient has sustained a catastrophic brain injury, the appropriate health professional must conduct, among other things, the following clinical interview: a Structured Interview for the Glasgow Outcome Scale.
5-Traumatic Brain Injuries for a person under the age of 18 at the time of the accident
The scale is dependent upon imaging of the brain, extent of admission to a rehabilitative facility and the King’s Outcome Scale for Childhood Head Injury, as published in Crouchman, M. et al
And where 2 or more years have elapsed since the accident, or where, after 3 months, a physician is of the belief that the patient’s condition is unlikely to improve and,
6- Physical Impairment
55% or more physical impairment of the whole person pursuant to the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition (1993)
7-Mental or Behavioural Impairment Combined with Physical Impairment
A mental or behavioural impairment, excluding traumatic brain injury, that, when the impairment score is combined with a physical impairment described in paragraph 6, results in 55 percent or more impairment of the whole person.
8. Mental or Behavioural Impairment
An impairment that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993 results in a class 4 impairment (marked impairment) in three or more areas of function that precludes useful functioning or a class 5 impairment (extreme impairment) in one or more areas of function that precludes useful functioning, due to mental or behavioural disorder.
Along with these tests, a patient must also undergo a neuropsychological assessment and must meet the following criteria to obtain what is deemed “catastrophic status”. The patient must have positive MRI findings, vegetative or disability rating on the Glasgow Outcome Scale (as mentioned above) , significant decreased activities of daily living via client interview, interview of treating practitioners (mentioned above) and/or a file review of collateral medical documents.
The definition and criteria for a catastrophic injury can be confusing and complex. We have provided a quick snapshot here. Our personal injury lawyers are happy to speak with you to go over any specific questions you may have.