Determining Catastrophic Impairment

Under Ontario’s Statutory Accident Benefits Schedule (SABS), there are three tiers of injuries. These tiers are used to determine the level of financial compensation available to an injured person.

The upper tier of injuries consists of catastrophic impairments. Individuals who are catastrophically injured have access to the highest levels of compensation to fund their treatment and recovery.

Because of the amount of compensation at stake, receiving this designation can be difficult. In the catastrophic impairment case we discuss below, the adjudicator had to determine whether Ms. Carmen Teutloff was catastrophically impaired as a result of her motor vehicle accident.

The Background

Ms. Teutloff’s motor vehicle accident occurred on June 5, 2014. Although her story varied and there was no police report to support it, she held that she lost control and swerved off the road while driving home on a rural road. She said that she crashed into some trees, which is what stopped the vehicle.

Ms. Teutloff’s daily life was significantly impacted by the trauma of the accident and her injuries.  She quickly became unable to perform simple tasks such as cooking and cleaning. She was unable to return to any of her places of work and she became intolerant of her granddaughter who lived with her and for whom she had previously cared. Ms. Teutloff seldom went to church on Sundays, stopped volunteering and rarely socialized with friends.

Determining Catastrophic Impairment

Ms. Teutloff sought benefits for catastrophic impairment pursuant to the SABS. Under the SABS guidelines, catastrophic impairment is defined in accordance with the American Medical Associations Guides to the Evaluation of Permanent Impairment, 4th edition, 1993 (“Guides”).

An impairment is considered catastrophic if it results in Class 4: Marked Impairment or Class 5: Extreme Impairment due to mental or behavioural disorder. The severity of impairments is further classified according to how seriously a person’s useful daily function is impacted in four categories:

  • Activities of Daily Living
  • Social Functioning
  • Concentration, Persistence, and Pace
  • Adaptation

Within each of these categories, impairments are rated on a five-point scale that ranges from no impairment to extreme impairment.

Ms. Teutloff held that she had marked impairment in the categories of Concentration, Persistence, and Pace as well as Adaptation. Ms. Teutloff was assessed by her own medical specialist and that of her insurer.

The Case

In February 2022, Madam Adjudicator Kate Grieves heard Ms. Teutloff’s case at Ontario’s Licence Appeal Tribunal (LAT). Ms. Grieves was tasked with determining whether or not Ms. Teutloff had sustained a catastrophic impairment as a result of her motor vehicle accident.

Ms. Teutloff had been assessed by medical specialists on both sides of the case. At the LAT, she submitted that Dr. Lawson, her insurer’s medical specialist, underrepresented the ratings he gave her. To back up that submission, she relied on medical records and reports, her own testimony, as well as testimony from her husband, a friend, a rehabilitation support worker, and a number of experts who support that Ms. Teutloff met the criteria for catastrophic impairment.  

Her insurer, however, had a number of counterarguments. They held that Ms. Teutloff’s own testimony was not credible, considering that her reports of how the accident occurred were inconsistent. They argued that her symptoms and impairments were overstated, and her impairments were not the result of the accident. To this latter point, they added that Ms. Teutloff’s impairments were the result of medication and alcohol use as well as post-accident incidents.

The Result

Ms. Grieves did accept some of the submissions of the respondent. She agreed, for example, that Ms. Teutloff’s account of the events of the motor vehicle accident did indeed vary. She also agreed that Ms. Teutloff’s medication and alcohol use, as well as post-accident incidents, were complicating factors in determining her level of impairment.

However, Ms. Grieves accepted that Ms. Teutloff’s current impairments were the result of injuries sustained in her accident. She held that the medical assessments on both sides concluded that Ms. Teutloff had suffered psychological impairment as a result of her accident and she considered the totality of the evidence in her ruling.

Importantly, Ms. Grieves came to these conclusions on the basis of her assessments of credibility. She found that the medical assessment provided by Ms. Teutloff’s neuropsychologist was more credible than that provided by the insurer. Specifically, she found that the insurer’s report did not sufficiently address Ms. Teutloff’s inability to return to work and that the extent of her impairments was not accurately described.

Have You Been Catastrophically Impaired?

Catastrophic impairment can significantly impact your ability to return to the activities of daily life, which is why the SABS provides the highest level of financial compensation for this degree of injury. This compensation is intended to help pay for medical bills as well as cover expenses such as lost wages.

In many cases, this level of compensation requires that the injured party meet a high burden of proof. Organizing a case for catastrophic impairment, therefore, requires professional expertise and experience.

Here at Sharma Law, we are the experts in motor vehicle accidents. If you’ve been catastrophically injured, let us help you win the compensation you deserve. Contact us today to get started.

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