WHAT IS A “CATASTROPHIC” INJURY?

What Is a “Catastrophic” Injury?

For the purposes of the “catastrophic” designation, the SABS looks at impairments rather than the injury itself. Many injuries that at first instance appear catastrophic must result in a long-term impairment that meets the statutory criteria for “catastrophic impairment”. Since June 1, 2016, a Catastrophic Impairment has been defined to include 8 categories of impairments. The complete criteria can be found at section 3.1(1) of the SABS, also located here.

The 8 criteria can be summarized as follows:

1. Paraplegia or tetraplegia
2. Severe impairment of ambulatory mobility or use of an arm or leg, or amputation of an arm or leg
3. Loss of vision of both eyes
4. If the person is over 18: traumatic brain injury, provided that the brain injury is confirmed by medical imaging and a Glascow Outcome Scale assessment determines that the injury results in one of the following ratings:
   A. Vegetative State, one month or more after the accident,
   B. Upper Severe Disability or Lower Severe Disability, six months or more after the accident, or
   C. Lower Moderate Disability, one year or more after the accident.
5. If the person is under 18 years of age: a traumatic brain injury, confirmed by medical imaging, and the person has been admitted into hospital, or, the person has severely impaired neurological functioning
6. A physical impairment or combination of physical 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 physical impairment of the whole person.
7. A mental or behavioural impairment, excluding traumatic brain injury, determined in accordance with the rating methodology in the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 6th edition, 2008, that, when the impairment score is combined with a physical impairment described above results in 55 percent or more impairment of the whole person.
8. 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.

The foregoing is a summary of the criteria required for Catastrophic Impairment. Each of the 8 criteria above are expanded upon in the legislation. It is important that your health care provider review the expanded criteria before arriving at an opinion as to whether you are catastrophically impaired. It often requires specialized knowledge or training, such as a familiarity with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, and an understanding of the Glascow Outcome Scale and the ASIA Impairment Scale.

Who determines whether I have sustained a “Catastrophic” Injury?

In order to be deemed Catastrophically Impaired, the auto insurer requires the completion of a form called an OCF-19, Application for Determination of Catastrophic Impairment. This form is available here.

A physician or, in the case of a traumatic brain injury, a neuropsychologist, must complete this form and send it to the auto insurer. Sometimes, the use of an occupational therapist, psychologist and speech language pathologist may supplement or add to the assessment by your treating health care provider as to whether you have sustained a Catastrophic Impairment. An occupational therapist and psychologist may be particularly helpful where the injury that forms the basis of the Application is a mental or psychological impairment. A speech language pathologist can also provide assistance in the assessment of catastrophic impairment in the context of a traumatic brain injury.

We are available to meet with you at the Hospital, rehabilitation centre, home, or of course, our office. Our consultations are always free,

Please contact Pranzitelli Law Firm today.