The term “Catastrophic Impairment” is a term from the auto insurance sector, in which individuals who have sustained serious and complex injuries are entitled by law to a larger set of funds for treatment and supports after an automobile accident.
In Ontario each year, 65,000 people are injured in automobile accidents. Of those accidents, 24% result in serious, life-threatening injuries. Only 1% of those life-threatening injuries are deemed to be Catastrophic by way of the SABS definition and determinations (Ontario Rehab Alliance).
Will I Have Sufficient Treatment Funding if I am Injured in an Automobile Accident?
Most people’s basic mandatory auto insurance package does not provide sufficient coverage for serious injuries. However, you can opt to purchase additional coverage by asking your auto insurer and by paying a slightly higher premium.
What are Medical and Rehab benefits?
Medical and Rehabilitation insurance benefits cover medically-necessary goods and services that are not covered by OHIP. These services include things like physiotherapy, counselling with a psychologist, medications, or nursing, for example. Attendant Care benefits cover things like personal support workers to assist with bathing, dressing, and housekeeping for example.
How Can I Access Treatment after an Accident?
After an accident, your access to necessary funds for treatment are at the discretion of your insurance company.
It is important to make sure you find treatment providers who are knowledgeable about the auto insurance industry and can work collaboratively with your insurance adjuster and/or lawyer to help you get the treatment you need.
Our Psychologists and Neuropsychologists can help. We are used to working with insurance adjusters, lawyers, family physicians, and multidisciplinary teams. We are a licensed FSCO Service Provider with licensed treatment facilities in Burlington, St. Catharines, and Owen Sound. We can assist with submitting forms and paperwork via the Health Claims for Auto Insurance (HCAI) web portals.
Definition of Catastrophic Impairment
Formal definitions of Catastrophic Impairment can be found online in a legal document called the “Statutory Accident Benefits Schedule (SABS)”. The SABS is a regulation within the Insurance Act of Ontario. Whether an accident victim meets the Catastrophic Impairment criteria depends on whether their accident occurred prior to, or after, June 1, 2016, as the criteria are slightly different depending on when the accident occurred.
Accidents Before June 1, 2016
In brief, accidents that occurred prior to June 1, 2016, the SABS defines a Catastrophic Impairment as being any of the following:
- paraplegia or quadriplegia;
- amputation, or total permanent loss of use of, an arm or leg
- the total loss of vision in both eyes;
- brain impairment that, in respect of an accident, results in
- a score of 9 or less on the Glasgow Coma Scale (a measure of conscious awareness level), or
- a score of 2 (vegetative) or 3 (severe disability) on the Glasgow Outcome Scale (a measure of functional outcome after brain injury) according to a test administered more than six months after the accident by a person trained for that purpose,
- an impairment or combination of impairments that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in 55 per cent or more impairment of the whole person; or
- 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) or class 5 impairment (extreme impairment) due to mental or behavioural disorder.
Accidents On, or After, June 1, 2016
For accidents that occurred on, or after, June 1, 2016, the SABS defines a Catastrophic Impairment as being any of the following:
- Paraplegia or Tetraplegia;
- Severe impairment of ambulatory mobility or use of an arm, or amputation;
- Loss of Vision of Both Eyes;
- Traumatic Brain Injury (applicant 18 years of age or older at the time of the accident);
- Traumatic Brain Injury (applicant under 18 years of age at the time of the accident);
- Physical Impairment or Combination of Physical Impairment which results in 55% or more of whole person.
- Mental or Behavioural Impairment, Excluding Traumatic Brain Injury, Combined with a Physical Impairment which results in 55 percent or more impairment of the whole person. (see “Additional Criteria” below); and/or
- 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 functioning, due to mental or behavioural disorder.
The completion of the Application for Determination of Catastrophic Impairment (OCF-19) is restricted to medical doctors and psychologists. Our Psychologists can help.