Catastrophic impairment is a legal test with major consequences for care funding.

The applicable route depends on the injury, the person’s age, the accident date and the available assessment tools. Some criteria rely on defined medical scales or whole-person impairment methods. Others address specific injuries or functional outcomes.

The legal and clinical team should identify the possible criterion early, while being honest about whether the condition is sufficiently stable and whether a required assessment period has passed.

The prescribed OCF-19 is the application for a determination of catastrophic impairment. FSRA publishes the current form.2 The form and accompanying assessments should address the specific regulatory language rather than simply describe the injury as severe.

Catastrophic impairment can change the limits and availability of medical, rehabilitation and attendant-care benefits. It may also affect access to certain optional benefits, depending on the policy and current regulation.

The designation does not guarantee that every proposed service will be funded. Treatment, assessment and attendant-care claims still have to meet the applicable SABS requirements.

Keep the OCF-19, all supporting reports, insurer-examination material and the explanation of benefits. Identify whether the dispute concerns the criterion, methodology, permanence, timing, causation or sufficiency of evidence.

Disputes about accident-benefit entitlement are generally brought to the Licence Appeal Tribunal’s Automobile Accident Benefits Service.3

A useful review should reduce the file to a defined benefit, disputed period, governing test and evidence problem—then explain the available response in plain language.

• Identify the benefit, policy, insurer and legal test that apply.
• Answer the denial with medical, functional and financial evidence.
• Protect application, examination, LAT and reconsideration deadlines.

See how an Ottawa accident benefits lawyer may help →