New Definition of Catastrophic Impairment

By Roger Foisy on June 15th, 2012

Expected Changes to Availability of Auto Accident Benefits with New Definition of Catastrophic Impairment.

With a new and more limited definition of catastrophic impairment potentially going to be implemented by the Ontario government, there is a deep concern that those who suffer serious injuries in motor vehicle accidents will not receive the compensation they need for adequate medical treatment, rehabilitation and support. In other words, it is a great win for insurance companies.

A recommendation report was undertaken by the Financial Service Commission of Ontario (FSCO), a regulatory agency created by the Ontario government. The objective of the report was for FSCO to consult with the medical community and make recommendations primarily on how the definition of ‘catastrophic impairment’ should be amended.

The recommendations in FSCO’s final report, if adopted, would essentially place restrictions on how catastrophic impairment would be determined in motor vehicle accidents. Existing regulation already states that catastrophic impairment includes the serious injuries of paraplegia, tetraplegia or quadriplegia, severe impairment of ambulatory mobility, blindness, traumatic brain injury, and physical and psychiatric impairment.

CAT Law Definition CanadaHowever, in the report, the legal threshold requirements of various medical tests and examinations used to determine these catastrophic injuries are overly stringent, excessive and would result in a delay in benefits. The implication is that it will be more difficult for those seriously injured in motor vehicle accidents to attain a catastrophic impairment designation. Standard accident benefits without this catastrophic impairment designation are much more limited. Those that suffer serious injuries may find that they must resort to out-of-pocket expenses in order to cover their medical, rehabilitation and support needs. Undoubtedly, if this report serves as guide for legislation, it is the insurance companies that will be the beneficiaries and not the consumers who purchase their insurance policies. In the place of fairness and justice, such legislation would leave a great void for the seriously injured seeking accident benefits in the hopes of piecing back together their lives.

Claimants that would have otherwise been classified as having ‘catastrophic’ impairment may find themselves downgraded to ‘non-catastrophic’ impairment. The difference in the standard accident benefits received depends on what designation is assigned to the injured person. In ‘non-catastrophic’ impairment standard medical and rehabilitation benefits are a maximum of $50,000 over 10 years, and standard attendant care benefits are a maximum of $36,000 over 2 years (to a maximum of $3000 per month).

For ‘catastrophic’ impairment the standard accident benefits coverage significantly increases as medical and rehabilitation benefits are a maximum of $1 million for life, and attendant care benefits are a maximum of $1 million for life (to a maximum of $6000 per month). In standard policies housekeeping and home maintenance benefits of $100 per week are only available to those who are classified as catastrophically impaired. Under standard medical and rehabilitation benefits, case manager services are provided for those who suffer catastrophic impairment. Case managers aid in in the co-ordination of goods and services such as treatment, rehabilitation and care. However, for catastrophic and non-catastrophic impairment optional benefits for additional coverage can be purchased through insurance providers.
What these numbers illustrate is the significant disparity between the standard accident benefits that are available to those suffering catastrophic impairment compared to those with a non-catastrophic impairment designation. With an increased threshold in determining catastrophic impairment more accident injury sufferers will be vulnerable. While there are voices that stand to oppose this becoming legislation, the future for those suffering serious injuries from car accidents remains uncertain.

Click link to view the full recommendation report by FSCO located on Ontario’s Ministry of Finance website.

(Photo Via: Digitized Chaos)

Roger Foisy

Roger R. Foisy is an experienced Ontario Personal Injury Lawyer helping accident victims and their families in Mississauga, Milton, Georgetown, Brampton, Oakville, and surrounding areas. Roger and his team dedicate a very personal level of attention to each and every client in their care and maximize clients’ personal injury settlements.
Roger Foisy

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