In determining a patient’s whole person catastrophic impairment, the practice of combining assigned percentages to psychological impairments with physical impairment ratings was recently upheld by the Financial Services Commission of Ontario (FSCO). Catastrophic impairment is a special impairment rating that allows for additional insurance coverage. It requires at least a 55% whole person impairment rating.
The case under review was Maria Augello and Economic Mutual Insurance Company. Ms Augello had been injured in a 2002 motor vehicle accident and subsequently assessed for a catastrophic impairment. This was not a precedent-setting case since a similar ruling was handed down in the case of Desbiens V. Mordini [2004] and upheld in the courts. That case was cited and considered in the Augello ruling. The reasoning in the earlier case assigned a numerical value or rating to each of psychological, physiological and anatomical losses of function. Combined, they provided a whole person impairment rating.
The practice of combining psychological and physical impairment assessments had, to this point, been controversial because Ontario’s Statutory Accident Benefits Schedule (SABS) incorporates the American Medical Association’s Guide to the Evaluation of Permanent Impairment. Its interpretation of permanent impairment is that which results in a patient being markedly or extremely impaired due to mental or behavioural disorders.
In the recent case Economic Mutual’s assessors disagreed with the use of an AMA formula in Ontario legislation, as do most insurers, because it affects the scale of benefit payments. Without considering the psychological percentages, they concluded that Ms Augello’s whole person impairment score was 20%. However, they did agree that should the psychological percentages be included, then the whole person impairment would indeed be 55%. The Desbiens v. Mordini ruling created a uniform approach which did not exclude the psychologically injured who, historically, had been in a disadvantaged position.
In its ruling, the FSCO noted that the combination of assigned percentages to psychological impairments and physical impairment ratings was consistent with the purpose of Ontario’s accident benefits legislation [SABS Regulation 121.(2.2.)].
