CATASTROPHIC IMPAIRMENT RATING
When a person develops chronic health problems after an injury, they can cause disabilities and impairments that may affect them for the rest of their lives. Doctors, lawyers and insurance providers use a standardized approach that helps to evaluate how disabled or impaired a person has become. This was first developed by the American Medical Association in 1971, and was called the AMA Guides to the Evaluation of Permanent Impairment.
While the AMA Guides is now in its 6th edition, the 4th edition is the medicolegal standard in Ontario that is used with the Statutory Accident Benefit Schedule (SABS) to evaluate impairments related to motor vehicle accidents.
In most cases, the impairments that are most relevant are those that involve the Musculoskeletal System, the Nervous System and the Mental and Behavioural system. In some cases, things like vertigo, sleep disorders and visual problems can create impairment affecting other systems.
Our background in integrative medicine has strengthened our ability to conduct superior assessments and identify impairments that may otherwise be missed. Our emphasis on communication, a patient-centered approach, a thorough symptom review and a focus on how diseases affect people’s lives yield impairment ratings that are more accurate and comprehensive and better reflect a person’s true ability to function and live independently.
We provide two medicolegal services for people with ongoing legal and insurance-related issues that require an evaluation of impairment:
- File Review – this includes a review of the accident history, the symptoms that are still present, the diagnoses and treatments that were provided and the impact of these diagnoses on a person’s life. If the impairments are significant enough that the person might be considered to have suffered a catastrophic injury, an OCF19 formwill be completed. This includes a Brief Report that summarizes the situation and includes a list of possible impairments.
- Impairment Rating – this is a more in-depth analysis of each individual impairment, along with a number representing the percentage of Whole-Person Impairment (WPI) attributed to it. The individual impairments are combined to obtain a final WPI that can be used for medicolegal and insurance purposes.
These services combine three separate areas of skills and expertise:
- Clinical medicine skills are required to interpret and review symptoms, test results, diagnoses and treatments. Sometimes reports are provided by specialists who have a deep understanding of one system but little to no understanding of the others. The treatment of chronic pain requires an understanding of disorders of the Musculoskeletal, Nervous and Mental and Behavioural systems.
- Impairment rating skills are essential as the AMA4 guides is the standard textbook that the SABS (the law in Ontario) is based on. The American Academy of Disability Evaluating Physicians (AADEP) trains and certifies doctors to use the AMA Guides to evaluate impairment.
- Case law provides examples of how the law in Ontario has been interpreted by judges in real cases. The Medico-Legal Society of Toronto is a forum where these cases are presented and discussed. These cases are important to understand in order to provide ratings and reports that meet the standards established by the legal community in Ontario. We are members of the MLST and have reviewed the most important cases since 2011.
There are many criticisms of the Guides, and some consider the newer editions to be better while others think it is worse. No system is perfect, and this one is no exception. While they were designed to be objective and consistent from one evaluator to the next, there is certainly some room for disagreement about just how impaired an individual is. That is why it is so important for evaluating physicians to be thorough, accurate, detail-oriented and objective.
Our services are provided in Ottawa and Toronto, but in certain circumstances they may be provided in other parts of Ontario.