A catastrophic impairment designation places you – an auto accident victim – in the highest level of impairment category available under automobile insurance regulations. While not a benefit itself, a catastrophic impairment designation is the gateway or vehicle to access enhanced benefits, where your policy limits increase to $1 million. All other impairments fall under the non-catastrophic and minor injury category.
If you or your healthcare provider thinks that your accident-related injuries satisfy the legislative criteria of a catastrophic impairment, which is set out in section 3.1(1) of the SABS 34/10, then Rudder Law Group will help you to get your healthcare provider or treating specialist to submit an Application for Determination of Catastrophic Impairment (OCF-19) form to your insurer. It’s of the utmost importance that you select the right healthcare provider or treating specialist, in that the nature of your accident-related injuries falls within the scope of practice of the healthcare provider or treating specialist.
If you want to learn more about catastrophic impairment law, as well as the criteria that must be satisfied in order to obtain a catastrophic impairment designation, which increases your automobile insurance policy limits to $1 million, then please click the “link” to read my blog entitled “What is a Catastrophic Impairment?”.
If on the basis of this Application, your insurer concludes that your injuries are deemed to satisfy the criteria for a catastrophic impairment, then your insurer will designate you as catastrophically impaired. Then you’ll transition to the catastrophic injury/impairment classification, where your applicable accident benefit policy limits would increase to at least $1 million, unless you have purchased any optional increased benefits under your automobile insurance policy. Furthermore, the catastrophic impairment designation will grant you access to the highest tier of accident benefits, thereby entitling you to request extended medical rehabilitation and attendant care benefits, and other expenses. Your insurer may request a section 44 insurer’s medical examination, where they’ll retain a physician to assess you for the purpose of determining whether or not you should be designated as catastrophically impaired. If their physician determines that you’re not catastrophically impaired, then I can retain a physician to assess you and complete a rebuttal medico-legal report, and proceed to appeal the insurer’s determination to the Licence Appeal Tribunal.
Pursuant to the the legislative criteria of a catastrophic impairment, which is set out in section 3.1(1) of the SABS 34/10, you can obtain a catastrophic impairment, if as a direct result of your motor vehicle accident, you sustain, but not limited to, the following:
- Paraplegia or tetraplegia pursuant to the American Spinal Injury Association (ASIA) impairment scale or the Spinal Cord Independence Measure (SCIM), Version III, you require urological surgical diversion, an implanted device, or intermittent or constant catheterization in order to manage your residual neuro-urological impairment, or you have impaired voluntary control over anorectal function that requires a bowel routine, a surgical diversion or an implanted device.
- Severe impairment of the ambulatory mobility or use of your arm, or an amputation that results in an trans-tibial or higher amputation of your leg, or an amputation of your arm or another impairment that causes the total permanent loss of the use of your arm, pursuant to the SCIM, Version III;
- The loss of vision of both of your eyes, even with the use of corrective lenses or medication, provided (1) your visual acuity in both eyes is 20/200 (6/60) or less as measured by the Snellen Chart or an equivalent chart such as, but not limited to the LogMAR Chart or Bailey-Lovie Chart, or (2) the greatest diameter of the field of vision in both of your eyes is 20 degrees or less, and the loss of your vision is not attributable to non-organic causes;
- If you’re an adult, then a traumatic brain injury that’s either established by (1) positive findings on a computerized axial tomography scan (CAT scan), a magnetic resonance imaging (MRI) or any other medically recognized brain diagnostic technology indicating intracranial pathology, including, but not limited to, intracranial contusions or haemorrhages, diffuse axonal injury, cerebral edema, midline shift or pneumocephaly, or (2) when assessed pursuant to the Extended Glasgow Outcome Scale (GOSE) you have a rating of either vegetative state, upper severe disability, lower severe disability, or lower moderate disability;
- If you’re a child, then a traumatic brain injury that’s established by (1) acceptance for admission, on an in-patient basis, to a public hospital with positive findings on a CAT scan, a MRI, or any other medically recognized brain diagnostic technology indicating intracranial pathology, including, but not limited to, intracranial contusions or haemorrhages, diffuse axonal injury, cerebral edema, midline shift or pneumocephaly; (2) acceptance for admission, on an in-patient basis, to a program of neurological rehabilitation in a paediatric rehabilitation facility that is a member of Empowered Kids Ontario – Enfants Avenir Ontario; or (3) when assessed pursuant to the King’s Outcome Scale for Children Head Injury (KOSCHI) your level of neurological function does not exceed category 2 (vegetative), category 3 (severe disability), or your level function remains seriously impaired such that you are not age-appropriately independent and require in-person supervision or assistance for physical, cognitive or behavioural impairments for the majority of your waking day;
- A physical impairment or combination of physical impairments that, in accordance with the American Medical Association’s (AMA’s) Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in 55 percent or more physical impairment of your whole person;
- A mental or behavioural impairment, excluding a traumatic brain injury, determined in accordance with the rating methodology in Chapter 14, Section 14.6 of the AMA’s Guides to the Evaluation of Permanent Impairment, 6th edition, 2008, that, when your impairment score is combined with a physical impairment described in paragraph 6 in accordance with the combining requirements set out in the Combined Values Table of the AMA’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in 55 percent or more impairment of your whole person;
- An impairment that, in accordance with the AMA’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 your diagnosed mental or behavioural disorder.
At Rudder Law Group, we understand that after sustaining a catastrophic impairment and experiencing a devastating, unforeseen loss, you want to optimize your level of independent living and be able to pay for the exorbitant costs of future care, so as to avoid undue stress and hardship. That’s why we are committed to fighting on your behalf to ensure that we increase your auto insurance policy limits to the highest tier of medical rehabilitation benefits in your accident benefits claim, as well as obtain just compensation in your tort action or lawsuit. We fight to accomplish this goal so you can pay for the exorbitant future costs of care, in order to gain access to the necessary multidisciplinary treatment, care services, and support needed to optimize your level of independent living, and your full mental, physical, social and vocational ability. We are committed to this in order to facilitate the optimization of your social and economic inclusion, and participation in all aspects of your life in society.