Changes to the Definition of Catastrophic Impairment

The survivors of motor vehicle collisions can sustain a number of injuries that impact various physical and cognitive functions. These injuries can also range in severity. They can be mild, healing naturally with time, treatment, and care. They can be severe, requiring a fulsome regimen of medical attention, including surgeries, long-term physiotherapy, and substantial periods of time away from work. But some injuries are even more severe. These permanent impairments can have profound effects on the life of a motor vehicle accident survivor, negatively impacting them for the rest of their lives.

The word used to describe these impairments both informally and legally is “catastrophic.” Legally speaking, the term “catastrophic impairment” is used by Ontario auto insurance providers to determine the amount of accident benefits to which an injured collision survivor should be entitled. The definition of “catastrophic impairment” is based on specific medical criteria. These criteria are outlined in Ontario’s Statutory Accident Benefits Schedule (SABS).

Several years ago, in consultation with the medical community, the Financial Services Commission of Ontario (FSCO) introduced amendments to the definition of “catastrophic impairment.” These amendments took effect on June 1, 2016, and are applied to survivors of motor vehicle accidents that took place after that date.

Changes to Qualifying Criteria

For anyone unfamiliar with the criteria previously used to determine whether accident-related injuries met the threshold for catastrophic impairment, the 2016 amendments to the provincial SABS may seem inconsequential. However, their introduction had sweeping repercussions for the people most severely impacted by motor vehicle collisions.

The amendments to the definition of catastrophic impairment introduced a new process for combining physical injuries with mental and behavioral impairments. The 2016 definition also included updated criteria for amputations, ambulatory mobility, loss of vision, and mental and behavioral impairments. Perhaps most noticeable, however, were the changes applied to the definition of catastrophic impairments related to traumatic brain injuries (TBIs) in adults over the age of 18.

Before these changes to the definition were implemented, physicians could use the Glasgow Coma Scale (GCS) as a tool to assess the severity of TBIs sustained by motor vehicle accident survivors. This numerical system was a metric upon which the determination of catastrophic impairment could be based. If a person received a GCS score of 9 or lower, they would have qualified for accident benefits commensurate with catastrophic impairments.

However, since the new definition of catastrophic impairment was put into effect on June 1, 2016, the metric used to measure the severity of a TBI was replaced with the Glasgow Outcome Scale-Extended (GOS-E) system. For many patients, this assessment can only be administered 6 months after the date of the accident. That means that people who have sustained catastrophic TBIs as the result of a motor vehicle accident are now required to wait half a year to undergo an assessment to prove whether they should be entitled to higher accident benefits amounts.

Additionally, insurance companies also require medical imaging results as proof of a catastrophic TBI before paying catastrophically injured accident survivors the benefits they are owed. In order to meet the new determining criteria for catastrophic impairment, the collision survivor must show positive findings of an accident-related TBI on a medically recognized brain diagnostic technology (such as an MRI or CT scan).

For a thorough comparison of changes made to the definitions of “catastrophic impairments” before the most recent amendments took effect in 2016, click here.

Changes to Available Benefits

In addition to the updated criteria used to determine whether or not an injury could be defined as a “catastrophic impairment,” when these amendments to the SABS were put into effect, another major change was glaringly apparent: the amount of benefits available to catastrophically impaired accident survivors had been substantially reduced.

Before the changes were introduced on June 1, 2016, motor vehicle accident survivors who had met the threshold of catastrophic impairments were entitled to $1 million for medical and rehabilitation benefits in addition to $1 million for attendant care benefits. Now that the amended SABS conditions have taken effect, catastrophically impaired collision survivors are only eligible for a combined total of $1 million for medical, rehabilitation, and attendant care benefits.

People who have been catastrophically impaired in a motor vehicle accident may require the assistance of an attendant or personal support worker (PSW) to carry out the daily activities of everyday life. Now that people who have sustained catastrophic injuries are entitled to lower benefits amounts, it can be extremely difficult for them to afford the full cost of care they require.

If you were catastrophically injured in a collision caused by the negligence of another driver, our Ontario car accident lawyers may be able to help you pursue additional compensation by filing a civil claim against the at-fault motorist. To learn more about the accident benefits that might be available to you and the legal action you may be able to take to secure the compensation you deserve, contact us today and take advantage of a free initial consultation.