SAB Benefits for Catastrophic Mental Impairment
If you are insured and have been injured in a car accident, you are entitled to Statutory Accident Benefits (“SABs”). SABs are what Ontario Lawmakers decided are the minimum benefits an insurance company can offer their clients who were injured in a car accident.
The amount of treatment SAB benefits depends on the severity of your injuries. SAB groups injuries into three different categories. These categories are minor, non-catastrophic and catastrophic. Catastrophic Injuries provide by far the best benefits. SAB benefits for CAT injuries can provide over 900,000 dollars more coverage in treatment than for non-catastrophic injuries.
There are several different ways to qualify for catastrophic impairment benefits following a motor vehicle accident.
One of the more common ways to qualify for catastrophic injury benefits is through mental and behavioural impairment.
A psychiatrist’s assessment is needed for mental and behavioural impairment to qualify as catastrophic. This assessment typically happens 2 years post the accident. The assessment can be earlier if a doctor’s assessment indicates your injuries are unlikely to improve.
The Different Spheres
Your psychiatrist assesses your impairment in 4 different spheres. These spheres were created by the American Medical Association. Each sphere represents a different aspect of life that can be affected by mental or behavioural impairment.
- The first sphere is “limitation in activities of daily living.” These are activities normally done in a day. Among activities included in this sphere are the ability to clean oneself; the ability to move and communicate effectively; and sexual function. Impairment is judged by the ability to initiate and take part in these activities without aid.
- The second sphere is “social functioning”. This is the ability to participate in group activities and communicate with other people. Some ways this area of impairments is displayed is through a history of: altercations, evictions, firings, fear of strangers, avoidance of interpersonal relationships and social isolation. The psychiatrist assesses the number of areas impaired and the severity of an impaired area in his/her evaluation.
- The third sphere is “concentration, persistence and pace”. This is the ability to focus and complete tasks. To evaluate this, the psychiatrist will ask you to perform some tasks. He/She will track the time it takes to complete the task and the number of errors made while performing the task. This data will aid in his/her assessment of you in this sphere.
- The final sphere is “deterioration or decompensation in work or work-like settings.” This is the ability to handle stress. This is assessed through four different areas: The ability to understand and remember different workplace procedures, the ability to sustain concentration; the ability to interact socially in work settings; and the ability to adapt to stressful situations. The psychiatrist scores your ability to handle these situations.
The Scoring Requirements
Your psychiatrist gives you a score from 1 to 5 in each sphere. A score of 1 represents no impairment. A score of 2 represents mild impairment. This means your impairment does not interfere with most useful functioning in that sphere. A score of 3 represents moderate impairment. This means your impairment interferes with some but not all useful functioning.
A score of 4 represents a marked impairment. This means your impairment levels significantly impede useful functioning in that sphere. A score of 5 represents extreme impairment. This means your impairment precludes any useful functioning in that sphere.
For catastrophic impairment, the important scores are the fours and fives. If you were injured in an accident after June 1, 2016, you must have three spheres with a score of 4 (marked impairment) or one sphere with a 5 (extreme impairment) to qualify for catastrophic injury benefits. The difference between a score of 1 and 3 does not affect your ability to qualify for catastrophic injury benefits.
Prior to June 1, 2016, the threshold was lower. You only needed a score of 4 (marked impairment) in 1 of the 4 spheres to qualify for catastrophic injury benefits. This threshold still applies if you are suing for injuries suffered before June 1, 2016.
If you or someone you know was injured in a motor vehicle accident, contact Littlejohn Barristers at 705-725-7355. We are a leading personal injury law firm in Barrie. We would love to speak with you.