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CATASTROPHIC IMPAIRMENT IN MOTOR VEHICLE ACCIDENTS
Statutory Accident Benefits Schedule Regulation of the Insurance Act Last amendment: O. Reg. 347/13.
A catastrophic impairment caused by an accident is,
(a) paraplegia or quadriplegia;
(b) the amputation of an arm or leg or another impairment causing the total and permanent loss of use of an arm or a leg;
(c) the total loss of vision in both eyes;
(d) subject to subsection (4), brain impairment that results in,
(i) a score of 9 or less on the Glasgow Coma Scale, as published in Jennett, B. and Teasdale, G., Management of Head Injuries, Contemporary Neurology Series, Volume 20, F.A. Davis Company, Philadelphia, 1981, according to a test administered within a reasonable period of time after the accident by a person trained for that purpose, or
(ii) a score of 2 (vegetative) or 3 (severe disability) on the Glasgow Outcome Scale, as published in Jennett, B. and Bond, M., Assessment of Outcome After Severe Brain Damage, Lancet i:480, 1975, according to a test administered more than six months after the accident by a person trained for that purpose;
(e) subject to subsections (4), (5) and (6), 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
(f) subject to subsections (4), (5) and (6), 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. O. Reg. 34/10, s. 3 (2).
- Partial paraplegia or quadriplegia are sufficient to meet the criteria for catastrophic impairment
- If at any moment the GCS reading is “9 or less”. It matters not if the score improves quickly.
- There is case law to support the position that if a medically appropriate GCS registers “9 or less” within a reasonable time after the accident, where the brain impairment as a result of the accident is not contested, this satisfies the criteria even if taken once a person is intubated.
- Six months after the accident, brain injury survivors can be assessed using the Glasgow Outcome Scale. The Scale is based on overall social compatibility or dependence of the client. It takes into account the combined effect of mental and neurological deficits without listing them as part of the definition.
Catastrophic Injuries: There are four categories of survival:
- Vegetative State
- Severe Disability
- Moderate Disability
- Good Recovery
Where the patient has suffered a “severe disability”, she is deemed catastrophically impaired. A “severe disability” may include situations where an individual may function reasonably well with some ADLs but require assistance with others, may require supervision due to memory, fatigue, or some other impairment. The severe disability may be a combination of mental and physical impairments.
- In determining Whole Person Impairment, the law requires that mental impairments be combined with physical impairments to determine whether 55% is reached.
- Mental impairment (when determining a marked or severe impairment) must be evaluated in accordance with each of these four categories:
- Activities of daily living;
- Social functioning;
- Concentration, persistence and pace;
- Adaptation to work or work-like settings.
In order to qualify as having sustained a “marked impairment”, the applicant must establish that:
“impairment levels significantly impede useful functioning”.
“Significantly” means “more than insignificant, more than minimally. It does not mean “completely”.
“Impede” means “obstruct”, “hinder” or “delay”.
A rating of “marked impairment” in one of the four categories is sufficient to be deemed Catastrophically Impaired.
Occupational therapists, physiotherapists, psychologists, social workers, and other health care professionals typically evaluate one or more activities of daily living in the course of their assessments.
Activities of daily living include: Self-care, personal hygiene, Communication, Physical Activity, Sensory Function, Hand Function, Travel, Sexual Function, Sleep, Social and Recreational activities.
Sleep and pain levels play a significant role in these assessments.
Contact an experienced personal injury lawyer for more information on catastrophic injuries.
For more on catastrophic impairment and determination please see the Statutory Accident Benefits Schedule, American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, or visit www.ottawainjury.ca/catastrophic-injury/
MINOR INJURY GUIDELINE (MIG) FOR MOTOR VEHICLE INSURANCE
per s.268.3 of the Statutory Accident Benefits Schedule – HIGHLIGHTS
This Guideline is focused on the application of a functional restoration approach in the management of minor injuries in the acute and sub-acute phases of the injury.
For the purposes of this Minor Injury Guideline:
a) minor injury means a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae. This term is to be interpreted to apply where a person sustains any one or more of these injuries.
b) sprain means an injury to one or more tendons or ligaments or to one or more of each, including a partial but not a complete tear.
c) strain means an injury to one or more muscles, including a partial but not a complete tear.
d) subluxation means a partial but not a complete dislocation of a joint.
e) whiplash injury means an injury that occurs to a person’s neck following a sudden acceleration-deceleration force.
f) whiplash associated disorder means a whiplash injury that:
(i) does not exhibit objective, demonstrable, definable and clinically relevant neurological signs, and
(ii) does not exhibit a fracture in or dislocation of the spine.
Exceptions: An insured person’s impairment does not come within the MIG if the insured person’s impairment is predominantly a minor injury but, based on compelling evidence provided by his or her health practitioner, the insured person has a pre-existing medical condition that was documented by a health practitioner before the accident and that will prevent the insured person from achieving maximal recovery from the minor injury if he or she is subject to the $3,500 limit referred to in section 18(1) of the SABS or is limited to the goods and services authorized under this Guideline.
The MIG does NOT include concussion/TBI, or psychological impairments such as anxiety disorder.
Duration of benefits: treatments provided will not typically exceed twelve weeks in duration following the date of the initial visit
Total funding for benefits: $3,500
Goods and services provided: Assessment, treatments, equipment (therabands, gym ball, lumbar roll), assistive devices.
Treatments to include. Activity Prescription; Education; Reassurance; Home Exercise, treatments for: pain management, increased function, and diagnostic imaging.
Still have a question about the Minor Injury Guideline or Ontario Accident Benefits?
For a complete copy of the Minor Injury Guideline with Fee Schedule for services, please see Financial Services Commission of Ontario website www.fsco.gov.on.ca or www.ottawainjury.ca/insurance-claims/
What can our Ottawa personal injury lawyers do for you ?
Fair question . We receive calls from clients who are about to settle their insurance claim with their adjuster and simply want to know should they ? It’s tough for our injury lawyers to answer this question without reviewing the file. Typically, when we receive a call of this nature, we set up a meeting (no charge) and look through the facts of the case. It’s important that everything be reviewing in case there have been areas of a personal injury file that were not discovered or covered by the insurance company. Almost every time, sure enough, our Ottawa injury lawyers are able to find many expenses that should have been covered or aspects of an accident benefits policy that were not being utilized . That’s not to say that the insurance company was deliberately hiding such coverage, it’s just that often times unless the person injured knows to ask for all the right benefits and coverages, some simply do not come up.
Ottawa injury lawyers analyze your case. Are you getting maximum compensation for your injuries ?
Our personal injury lawyers can analyze your case and in some cases discover that the insurance claim is in fact double or triple what the insurance company is looking to settle for. Thankfully, as long as you have not signed off on the settlement offer, there may still be time to recoup these amounts with the assistance of a personal injury lawyer. This absolutely makes it worth while to consult with an experienced personal injury lawyer. All it will cost you is time; probably close to an hour for this initial consultation. Our Ottawa personal injury lawyers make it even easier and will come to you.
If we think your case is worth more, we will advise you not to settle and we can step in to represent you and prepare a claim for you. It may delay the settlement; however this delay is in our opinion worth it as typically the settlement amount is significantly higher. Not to mention, you will be receiving benefits and treatments you may not have been receiving before our personal injury lawyers stepped in. This will hopefully speed up your recovery process.
This is a personal injury lawyer’s job…
You owe it to yourself to consult with one of our experienced personal injury lawyers. It’s our job to ensure that our personal injury clients are receiving the best possible treatments, as well maximum compensation. Our Ottawa personal injury lawyers understand what you are going through. An accident can change in your life and your family’s life in many ways you never thought possible. Let us help.
Personal injury Ottawa cases and award amounts.
Compensation for Dental Injury
Every accident is unique and our lawyers see many accident scenarios. While many people have dental plans, not all dental injuries are covered and dental expenses can be very expensive.
Our injury lawyers recently settled a case where a client was left unattended and fell off a table, while being treated. Due to the fall, our client suffered both physically and emotionally. Our injury lawyers knew that huge impact these injuries would have
on our client both now and in the future.
Injuries Resulting From Accident:
Our client suffered very serious personal injuries resulting from the accident, which included: a) Loss of front teeth; b) Laceration to upper gums; c) Head injury and facial trauma, including nasal fracture and eye injury, accompanied by swelling and pain; These injuries also brought on further injuries. Our client developed anxiety from being left alone and some psychological injuries from the trauma of the accident.
Compensation For Dental Injury and Psychological Injury:
After tough negotiations, we were able to get the insurance company to settle without them having to go to court. In a relatively short amount of time, we were able our client $110,000.00 in compensation, as well as compensation for her parents, as these injuries directly impacted their lives as well.
Our Personal Injury Ottawa Lawyers Can Help You:
Since 1999, we have been building our team of dedicated Ontario injury lawyers. We all share the same philosophy: we really care about the well-being and future of our clients. We make ourselves available day and night for meetings, phone calls , email or texts. Our injury lawyers are happy to provide you with free legal advice and help you and your family move forward with maximum compensation. We understand that you may not know where to start, our injury lawyers do. Whether you decide to pursue a case or not, it’s best you know your options so you can make an informed decision. You owe it to yourself and your family. For more information that relates to compensation for chronic pain and psychological injuries, visit www.ottawainjury.ca/psychological-and-mental-injuries