Changes to CAT Definition - Effective June 1, 2016

CHANGES TO THE CAT DEFINITION 

EFFECTIVE ACCIDENTS OCCURRING ON OR AFTER JUNE 1, 2016
 

CRITERION 1

Paraplegia or tetraplegia that meets the following criteria:

The insureds neurological recovery is such that a permanent grade on the ASIA Impairment Scale can be determined.
The person’s permanent grade on the ASIA is or will be,

a.  A, B or C, or
b.  D, and

i.    the person’s score on the Spinal Cord Independence Measure, Version III, item 12 (Mobility Indoors), and applied over a distance of up to 10 metres on an even indoor surface is 0 to 5,

ii.   the person requires urological surgical diversion, an implanted device, or intermittent or constant catheterization in order to manage a residual neuro-urological impairment, or

iii.  the person has impaired voluntary control over anorectal function that requires a bowel routine, a surgical diversion or an implanted device. 

CRITERION 2

Severe impairment of ambulatory mobility or use of an arm, or amputation that meets the following criteria:

i.   Trans-tibial or higher amputation of a leg.

ii.   Amputation of an arm or another impairment causing the total and permanent loss of use of an arm.

iii.  Severe and permanent alteration of prior structure and function involving one or both legs as a result of which the person’s score on the Spinal Cord Independence Measure, Version III, item 12 (Mobility Indoors), and applied over a distance of up to 10 metres on an even indoor surface is 0 to 5.

CRITERION 3

Loss of vision of both eyes that meets the following criteria:

i. Even with the use of corrective lenses or medication,

   a. visual acuity in both eyes is 20/200 (6/60) or less as measured by the Snellen Chart or an equivalent chart, or
   b. the greatest diameter of the field of vision in both eyes is 20 degrees or less.

ii. The loss of vision is not attributable to non-organic causes.

CRITERION 4

If the person was 18 or older at the time of the accident, a TBI that meets the following criteria:

The injury shows positive findings on a CAT scan, an MRI or any other medically recognized brain diagnostic technology indicating intracranial pathology as a result of the accident, including, but not limited to, intracranial contusions or haemorrhages, diffuse axonal injury, cerebral edema, midline shift or pneumocephaly.

When assessed in accordance with Wilson, J., Pettigrew, L. and Teasdale, G., Structured Interviews for the GOS and the E GOS the injury results in a rating of,

a. Vegetative State (VS or VS*), one month or more after the accident, 

b. Upper Severe Disability (Upper SD or Upper SD*) or Lower Severe Disability (Lower SD or Lower SD*), six months or more after the accident, or

c. Lower Moderate Disability (Lower MD or Lower MD*), one year or more after the accident.

CRITERION 5

If the insured person was under 18 years of age at the time of the accident, a TBI that meets one of the following criteria:

i.  The person is accepted for admission, on an in-patient basis, to a public hospital named in a Guideline with positive findings on a CAT, MRI or any other medically recognized brain diagnostic technology indicating intracranial pathology that is a         result of the accident, including, but not limited to, intracranial contusions or haemorrhages, diffuse axonal injury, cerebral edema, midline shift or pneumocephaly.

ii.  The person is accepted for admission, on an in-patient basis, to a program of neurological rehabilitation in a paediatric rehabilitation facility that is a member of the Ontario Association of Children’s Rehabilitation Services.

iii.  One month or more after the accident, the person’s level of neurological function does not exceed category 2 (Vegetative) on the King’s Outcome Scale for Childhood Head Injury (KOSCHI)

iv.  Six months or more after the accident, the insured person’s level of neurological function does not exceed category 3 (Severe disability) on the KOSCHI

v.   Nine months or more after the accident, the person’s level of function remains seriously impaired such that the person is not age-appropriately independent and requires in-person supervision or assistance for physical, cognitive or behavioural      impairments for the majority of the insured person’s waking day.

Criterion 5 applies to a person who was under the age of 18 at the time of the accident and whose impairment is not a catastrophic impairment within the meaning of subsection (1). O. Reg. 251/15, s. 3.

If the person’s impairment can reasonably be believed to be a catastrophic impairment for the purposes of criterion 6, 7 or 8 of subsection (1), the impairment shall be deemed to be the impairment referred to in criterion 6, 7 or 8 of subsection (1) that is most analogous to the impairment, after taking into consideration the developmental implications of the impairment. O. Reg. 251/15, s. 3. 

CRITERION 6

A physical impairment or combination of physical impairments that, in accordance with the AMA Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in 55 per cent or more physical impairment of the whole person.

The following conditions must be met:

• 2 years must have elapsed since the MVA
• an assessment conducted by a physician three months or more after the accident determines that,

i. the insured person has a physical impairment or combination of physical impairments determined in accordance with paragraph 6 of subsection (1), that results in 55 per cent or more impairment of the whole person, and

ii. the insured person’s condition is unlikely to improve to less than 55 per cent impairment of the whole person. O. Reg. 251/15, s. 3.

 CRITERION 7

A mental or behavioural impairment, excluding TBI, determined in accordance with Chapter 14, of the AMA Guides, 6th edition, 2008, that, when the impairment score is combined with a physical impairment using the Combined Values Table of the AMA Guides 4th edition, results in 55 % or more WPI.

The following conditions must be met:

• 2 years must have elapsed since the MVA
• an assessment conducted by a physician 3 months or more after the MVA determines that,

i.  the person has a physical impairment or combination of physical impairments, or a combination of a mental or behavioural impairment and a physical impairment that results in 55 per cent or more impairment of the whole person, and
ii. the person’s condition is unlikely to improve to less than 55 per cent WPI

CRITERION 8

An impairment that, in accordance with the AMA Guides to the Evaluation of Permanent Impairment, 4th edition, results in a class 4 impairment (marked) in 3 or more areas of function or a class 5 impairment (extreme) in 1or more areas of function

The following conditions must be met:

• two years have elapsed since the accident; or
•  a physician states in writing that the person’s impairment is unlikely to improve to less than a class 4 impairment (marked) in three or more areas of function that precludes useful functioning, due to mental or behavioural disorder. O. Reg. 251/15, s. 3.