New CAT definition should not combine psychiatric or mental/behavioural impairments with physical impairments: FSCO
June 12, 2012 by Canadian Underwriter
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Ontario’s regulator is recommending to the finance minister that physical impairments should not be combined with psychiatric or mental/behavioural impairments for the purpose of determining a catastrophic injury.
Ontario’s regulatory superintendent has thus adopted the recommendations of an expert medical panel in a report to the government posted on Financial Services Commission of Ontario’s (FSCO) website on June 12. It is up to the government whether or not to adopt the report recommendations.
FSCO’s long-awaited review of the catastrophic impairment definition was part of the government’s auto insurance reform package implemented in 2010.
The superintendent recommended that a combination of requirements be used to determine a psychiatric catastrophic impairment. However, psychiatric and physical impairments should not be combined for the purpose of determining a catastrophic impairment of the whole person, the superintendent writes in his Superintendent’s Report on the Definition of Catastrophic Impairment in the Statutory Accident Benefits Schedule.
“The panel had trouble understanding how combinations of physical and psychiatric conditions that independently do not meet the criteria for catastrophic impairment could be equated to a severe injury to the brain or spinal cord or to blindness,” the superintendent wrote. “I agree with the expert panel’s position that arriving at a designation of catastrophic impairment is not a simple additive process. I therefore accept the expert panel’s recommendation that the combining of physical and psychiatric impairments not be permitted.”
The superintendent also found that the catastrophic impairment definition should not allow pain to be quantified as a separate impairment.
“If the panel recommendations are implemented as stated in its report, psychological and behavioural impairments would no longer be included in the definition of catastrophic impairment,” the report notes. “These conditions include chronic pain and fibromyalgia. However, a claimant with one of these conditions may be able to meet the criteria for catastrophic impairment on psychiatric grounds.”
While restricting some parts of the definition of a catastrophic impairment, FSCO’s superintendent is also calling for automatic designation of catastrophic impairment for children (claimants under 18) and interim benefits for claimants “who unequivocally require intensive and prolonged rehabilitation.”
Interim benefits should be capped at $50,000, the superintendent recommends.
“A final determination of catastrophic impairment would be deferred until the natural course of the condition has unfolded,” the report says. “For example, an adult who sustains a very severe brain injury would be able to access interim benefits for six months, at which point an assessment would be conducted to make a final determination.”
The panel has also called for the following clinical tools to be used in determining a catastrophic impairment:
• American Spinal Injury Association (ASIA) classification for spinal cord injury.
• Extended Glasgow Outcome Scale (GOS-E) for traumatic brain injury in adults.
• Spinal Cord Independence Measure for severe difficulty with walking.
• Global Assessment of Function (GAF) for psychiatric disorders.
The ASIA classification for a spinal cord injury is a new addition to the definition of catastrophic impairment. The panel qualified the use of the ASIA scale, however, so that “participation in, or completion of, an in-patient spinal cord injury rehabilitation in a public rehabilitation hospital is not necessary in addition to the other requirements.”
The recommended definition of a catastrophic impairment replaces the Glasgow Coma Scale, which, the panel notes, “has proven a poor tool for predicting the long-term outcomes of traumatic brain injury,” and replaces it GOS-E.
The full contents of the report can be found at:
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