On April 15, 2011, the Financial Services Commission of Ontario (FSCO) released its expert repor [1]t on catastrophic impairment definition review. The recommendations are considered significant as they reflect a departure from the long-standing position of jurisprudence in Ontario for the definition of catastrophic impairment under the Statutory Accident Benefits Schedule [2], including the approach used in Desbiens v. Mordini [3].
The panel recommended the creation of an interim catastrophic impairment to ensure access to rehabilitation services while a final determination of catastrophic status is being determined. The panel was split on whether Glasgow Coma Scale (GCS) score of 9 was a useful measure of catastrophic impairment for brain injury. The report includes a literature review on inter-rater reliability and face validity of GCS.
Probably the most significant recommendation of the panel was to prevent the combining of physical and psychological impairments, an important finding following the Kusnierz v. The Economical Mutual Insurance Company [4] decision,
The Expert Panel did not find that combining physical and mental/behavioural conditions can be achieved in a valid and reliable way with the currently available methods of impairment crossrating. Moreover, the Expert Panel did not find sufficient evidence that combined impairment ratings are more clinically meaningful than using separate criteria. While 55% physical impairment establishes paraplegia as a prime example of catastrophic impairment, we did not find evidence for an equivalent threshold when physical and mental/behavioral impairments are combined. The Panel had difficulty understanding how combinations of physical impairments and psychological conditions that independently do not meet the criteria outlined in the revised version of 2(e) and 2(f) could be equated to a severe injury to the brain or, spinal cord or to blindness. Further investigation of this area is needed. Specifically defining a clinically comparable combined psycho-physical whole person impairment threshold that corresponds to the currently accepted physical threshold is needed. Therefore, until further scientific evidence is gained, we recommend that separate criteria and methods of evaluation be used for the determination of catastrophic impairment and that physical and psychiatric impairments not be combined for the purpose of catastrophic determination.
The Ontario Trial Lawyers Association [5], the largest organization of plaintiff-side lawyers in the Province, issued a newsletter for MPPs [6] in anticipation of this report. They are expected to respond to the FSCO report in full shortly.