The Minister of Finance has now released the Superintendent's Report on the Definition of Catastrophic Impairment in the Statutory Accident Benefits Schedule. The Superintendent's report recommends changes to the SABS definition that reflect the two reports submitted by the Catastrophic Impairment Expert Panel as well as consultations conducted last year by FSCO.
The recommended changes if implemented would update the catastrophic impairment definition to reflect current scientific knowledge. The chart below describes the current test and the proposed test for each impairment group covered by the definition as well as the evidence used by the Expert Panel to support the recommended changes.
In addition to changes to the definition, the Superintendent recommends the payment of interim benefits to some claimants awaiting catastrophic impairment designation and automatic designation to other claimants. Only some of the Expert Panel's recommendations regarding the qualifications of catastrophic impairment assessors has been accepted by the Superintendent.
The most contentious recommendation deals with the combining of physical and psychiatric impairments. The Superintendent agrees with the recommendation originally made by the Expert Panel that these impairments not be combined which reverses the direction provided in the 2004 court case, Desbiens v. Mordini. The Superintendent also recommended that the catastrophic impairment definition not allow pain to be quantified as a separate impairment which would exclude chronic pain and fibromyalgia as catastrophic impairments.
Impairment | Current Test | Proposed Test | Evidence |
paraplegia and tetraplegia (quadriplegia) | none | American Spinal Injury Association classification of spinal cord injuries | standard in medical practices literature suggests classification system is valid and reliable |
amputations | none | none | clinical and scientific judgment of Expert Panel members |
burn and crush injuries to limbs | not covered in SABS | Spinal Cord Independence Measure | clinical and scientific judgment of Expert Panel members The scientific evidence supports the validity and reliability of the SCIM |
blindness | none | Legal blindness | |
traumatic brain injuries in adults | Glasgow Coma Scale Glasgow Outcome Scale | Extended Glasgow Outcome Scale | strong psychometric properties and reliable when used with a structured interview and standard scoring algorithm |
other physical impairments | whole body impairment rating using American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition | whole body impairment rating using American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition, Chapters 3-13 | very little scientific literature supporting use for determining catastrophic impairment but Expert Panel found no alternative rating system |
psychiatric impairments | class of mental or behavioural disorder using American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition, Chapter 14 | Global Assessment of Functioning Scale | literature suggests scale has adequate reliability and validity |
combining physical and non-physical impairments | none but the courts have assigning whole body impairment scores to impairments under Chapter 14 of AMA Guides to allow combining with scores under Chapters 3-13 | no combining | no scientific literature to support combining physical and non-physical impairment ratings The physical and mental/behavioural impairement rating chapters were not developed to be combined |
traumatic brain injuries in children | none | King’s Outcome Scale for Children Head Injury | little scientific evidence to support so Expert Panel recommended a study be conducted |
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