Expediting a Catastrophic Application

February 18, 2015  |  By:  Michelle Baumann

When a person is seriously injured as a result of a motor vehicle accident, costs for medical, rehabilitation, and attendant care services are often substantial. In most cases in Ontario, those who suffer a catastrophic impairment are able to access up to $1,000,000 for medical and rehabilitation benefits and up to $1,000,000 for attendant care benefits through accident benefit claims with their own automobile insurer. Having access to such benefit limits can afford an injured person with many freedoms and much security during the recovery process.

There are a number of ways that an injured person can be declared catastrophically impaired. Some people are able to immediately be declared catastrophic; immediate opportunity is afforded to those who suffer paraplegia or quadriplegia, amputation, or total loss of use of either an arm or a leg, total loss of vision in both eyes, or brain impairment resulting in a score of 9 or less on the Glasgow Coma Scale.

Although not an immediate opportunity, those who suffer brain impairment that results in a score of 2 (vegetative) or 3 (severe disability) on the Glasgow Outcome Scale may also be declared catastrophically impaired if the test is administered after at least six months have passed since the accident.

For those who suffer serious injuries but who don’t meet any of the above noted criteria, there can often be delays in pursuing a catastrophic declaration. As a result of such delays, and with only $50,000 and $36,000 being otherwise available for med/rehab and attendant care benefits, people often exhaust their non-catastrophic limits long before being declared catastrophically impaired.
After a two year waiting period, the Statutory Accident Benefits Schedule confirms that an individual can apply for a catastrophic declaration if they have an impairment or combination of impairments that, in accordance with the AMA’s Guides to the Evaluation of Permanent Impairment, 4th edition (1993), results in 55% or more impairment of the whole person. A person can also make application in accordance with the Guides if, again after two years, they suffer an impairment that results in a class 4 (marked) or a class 5 (extreme) impairment due to mental or behavioural disorder.

The good news is that this two year waiting period can sometimes be bypassed! Although it is often overlooked, by healthcare professionals and insurers alike, the Schedule confirms that the two year waiting period need not be applied to an injured person who suffers an impairment that is “unlikely to cease to be catastrophic”. In such cases, an application can be pursued so long as a physician, or a neuropsychologist in limited cases, confirms in writing that the impairment is indeed unlikely to cease to be catastrophic.

Particularly for those that will exhaust their non-catastrophic benefit limits quickly, being declared as catastrophically impaired at the first opportunity is vitally important. The timing and justification of a catastrophic application requires thoughtful and careful consideration. Having the support of expert medical and rehabilitation professionals, as well as having access to a knowledgeable personal injury advocate, is highly recommended for those dealing with serious injuries.


Source: http://oatleyvigmond.com/expediting-catastrophic-application/#.VOTPSS5YwdU