Superintendent's Report on the Definition of Catastrophic Impairment in the SABS

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 The Superintendent agrees with the recommendation originally made by the Expert Panel that these impairments not be combined which reverses the direction provided in the 2004 court case, Desbiens v. Mordini.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