Effective June 1, 2016, the definition of catastrophic impairment (“CAT”) will change, pursuant to section 3.1(1) of Ontario Regulation 251/15 made under the Insurance Act. This paper will focus upon the first two subsections of the new CAT definition:
- (some forms of) paraplegia or tetraplegia [s. 3.1(1)(1)]; and
- (some forms of) severe impairment of ambulatory mobility or use of an arm, or amputation [s. 3.1(1)(2)].
These sub-sections reference and incorporate the use of medical literature. The literature references disability measurement scales, namely: the ASIA Impairment Scale and the Spinal Cord Independence Measure (“SCIM”). These scales will make it more difficult for lawyers and insurers to make prompt CAT determinations. Further, the SCIM contains ambiguities that will further frustrate timely and conclusive CAT determinations.
Notably, ambiguity may actually lead to favourable outcomes for insureds. By analogy, if in baseball a “tie goes to the runner”, in insurance law a “tie goes to the insured”.
Read full paper by Sloan Mandel and Deanna Gilbert: The New Catastrophic Definition: Paraplegia, Tetraplegia, and Severe Ambulatory Impairment