Comparison of Key Changes to Accident Benefits from Bill 59 to Bill 198

• paraplegia or quadriplegia;
• Amputation or other impairment causing the total and permanent loss of use of both arms;
• Amputation or other impairment causing the total and permanent loss of use of both an arm and a leg;
• Total loss of vision in both eyes;
• Brain impairment that, in respect of an accident, results in,
  1. a score of 9 or less on the Glasgow Coma Scale, as published in Jennett, B. and Teasdale, G., Management of Head Injuries, Contemporary Neurology Series, Volume 20, F.A. Davis Company, Philadelphia, 1981, according to a test administered within a reasonable period of time after the accident by a person trained for that purpose, or;
  2. a score of 2 (vegetative) or 3 (severe disability) on the Glasgow Outcome Scale, as published in Jennett, B. and Bond, M., Assessment of Outcome After Severe Brain Damage, Lancet i:480, 1975, according to a test administered more than six months after the accident by a person trained for that purpose;
• Subject to subsection (2) and (3), any impairment or combination of impairments that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in 55 per cent or more impairment of the whole person, or
• Subject to subsection (2) and (3), any impairment or combination of impairments that, in accordance with theAmerican Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in a class 4 impairment (marked impairment) or class 5 impairment (extreme impairment) due to mental or behavioural disorder; (“deficience invalidante”)

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• paraplegia or quadriplegia;
• Amputation or other impairment causing the total and permanent loss of use of both arms or both legs;
• Amputation or other impairment causing the total and permanent loss of use of one or both arms and one or both legs;
• Total loss of vision in both eyes;
• Brain impairment that, in respect of an accident, results in,SameSameSame

  Same

• (1.3) Subsection (1.4) applies if an insured person is under the age of 16 years at the time of the accident and none of the Glasgow Coma Scale, the Glasgow Outcome Scale or the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, referred to in clause (1.2) (e), (f) or (g) can be applied by reason of the age of the insured person. O. Reg. 281/03, s.1 (5)
• (1.4) For the purposes of clauses (1.2) (e), (f) and (g), an impairment sustained in an accident by an insured person described in subsection (1.3) that can reasonably be believed to be a catastrophic impairment shall be deemed to be the impairment that is most analogous to the impairment referred to in clause (1.2) (e), (f) or (g), after taking into consideration the developmental implications of the impairment. O.Reg. 281/03, s. 1(5).

• Secure a consent form signed by the claimant (OCF 5)
• Include all goods and services contemplated by the health professional/facility
• Ensure that there is no other coverage available or identify other coverage
• Plan must be certified by Health Practitioner as reasonable and necessary – Occupational Therapists, Nurse Practitioners and Speech-Language Pathologists are now included as “Health Practitioners” and can sign off on Treatment Plans
• Greater obligations to describe injury, sequelae and other relevant health history
• Explain consequences of releasing health information
• Incurred expenses are payable after 14 days if the insurer has not responded to the Treatment Plan
• Treatment Plan can also be used to obtain insurer approval for payment of assessments
• If the treatment Plan is denied – DAC within 5 days after selection of DAC (Insurer selects the DAC, if insured disagrees, F.S.C.O. selects the DAC)