Close-up of disabled businessman in wheelchair

Catastrophic Impairment for Whole Person Impairments (WPI)

 

A part of your Statutory Accident Benefits Claim (SAB) is assessing your overall level of physical and psychological impairments as a result of the accident. Whole Person Impairment, or WPI, is a calculation tool that determines whether or not your injuries meet the ‘catastrophic’ definition. This is measured in percentages based on a table found in the Fourth Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment. If a licensed physician determines that your injuries result in a 55 percent or more Whole Person Impairment (WPI) of your whole body, your injuries are considered catastrophic, by definition.


What Is a Catastrophic Impairment?

 

A regular impairment is defined in s.3(1) of the Statutory Accident Benefits Schedule (SABS) as “a loss or abnormality of a psychological, physiological or anatomical structure or function.” However, there are eight different ways for your injuries to be deemed catastrophic, with WPI being one of the more common methods to establish that catastrophic threshold. The others include paraplegia/tetraplegia, severe impairment of ambulatory mobility of an arm or amputation, loss of vision of both eyes, a traumatic brain injury, or a marked/extreme impairment in one or more areas of function that precludes useful functioning.

 

For all accidents occurring after June 1, 2016, a catastrophic injury, as considered under a basic policy, has a maximum benefit of $1 million that can be allocated for medical/rehabilitation bills and attendant care. A non-catastrophic injury has a maximum benefit of $65,000. Another difference is that a catastrophic injury has the additional benefit of Housekeeping & Home Maintenance valued at $100/week, along with Caregiver benefits of $250/week with an additional $50/week for each additional child. A non-catastrophic injury, however, has neither.

 

This difference between a catastrophic and non-catastrophic WPI assessment is crucial to your case and determines how many benefits you are eligible to recover from your SAB claim. 

 

How Is the 55 Percent Calculated?

 

A licensed physician will evaluate the severity of all the injuries that you have sustained from your accident. This is called a Whole Person Impairment Assessment. This assessment can be done by your family doctor, a surgeon, or any other licensed physician in Ontario. 

 

During the assessment, they use a technical calculation to combine all your injuries into a percentage. Each possible injury is given a percentage of how impaired your whole-person is as a result of that specific injury. If the sum of all your injuries is above 55 percent, the licensed physician will deem your injuries as catastrophic. More specifically, the courts have established in P.P. v Wawanesa Mutual Insurance Company, 2020 CanLII 94798 (ON LAT) that even a 53 percent assessment would be rounded up to the catastrophic level. However, 52 percent would be rounded down, as seen in 16-000013 v Peel Mutual Insurance Company, 2017 CanLII 33649 (ON LAT). This is the chart that physicians use to calculate how severe your injuries are. 


Combined Values Chart

 

The injuries can be a combination of mental/behavioural and physical injuries. For example, if you have physical impairments to your shoulder and also have a mental impairment like a loss of memory, those two injuries will be calculated and combined together in the WPI Assessment.


When Can My Injuries Be Assessed?

 

The assessments are typically done after two years have elapsed since the accident. However, assessments can also be done anytime after three months of the accident if your condition results in more than 55 percent impairment and is unlikely to improve to less than 55 percent (found in s.3.1(2) of the SABS 34/10)

 

This is a two-part test. The first one is that a physician must assess your injuries three or more months after your accident and must deem your combined injuries as 55 percent or more impairment of the whole person. If that is satisfied, the physician has to state if you are “unlikely to improve” to less than 55 percent impairment of the whole person. Recent case law on this matter has shown that the physician must be specific and certain in their medical conclusions that your condition is unlikely to improve to less than 55 percent (see 18-004112 v Belairdirect, 2019 CanLII 22219 (ON LAT)).


The Bottom Line

 

This blog post has broken down what a catastrophic injury is, how it is calculated, and when an assessment can be made regarding your injuries. If your injuries are considered to be catastrophic after a Catastrophic Assessment, you could be entitled to additional benefits to help you secure the effective care you need after an accident.

 

At Littlejohn Barristers, we are a team of lawyers who have substantive experience in Statutory Accident Benefits Claims and have secured many catastrophic injury awards to help our clients recover from their injuries. If you or someone you know has been hurt in a motor vehicle accident, do not hesitate to contact Littlejohn Barristers for a free initial consultation. 

 

0