The most serious motor vehicle accidents in Ontario are classified as “Catastrophic” by our Ontario insurance law. The term “Catastrophic” is a term of art; meaning that it carries its own legal definition; separate and apart from the common definition you would find in an English dictionary.
Being designated “Catastrophic” or “CAT” as its known in the medico-legal community is significant, as it provides accident victims and their families to a wider array of accident benefits, over a longer period of time. The advantages are significant such that insurers will fight very hard to find serious injured accident victims as not meeting the catastrophic definition.
Just because you’ve been involved in a serious car accident doesn’t mean that you will automatically be found to be catastrophic. There are a number of medico-legal tests which need to be met. In addition, there is one VERY important form that needs to be completed. This form is called the OCF-19 Application for Determination of Catastrophic Impairment form. You can find a link to the OCF-19 CAT form, along with other OCF claim forms on the Goldfinger Injury Lawyers website here.
The OCF-19 is only two pages in length. Which, by comparison to some other forms (like the OCF-1 or the OCF-3) makes it a short form. But just because the OCF-19 CAT Claim Form is short, by no means is it not important or can it be completed carelessly.
Part 1 of the OCF-19 is fairly straight forward. It requires that you completed the Applicant’s Name, Address and Telephone #. It also contains a box asking about the Applicant’s status:
+ Applicant is currently in a general hospital, rehabiliation centre, nursing home or chronic care facility
+ This is the first Application for catastrophic determination
+ This is a reapplication for catastrophic determination
It’s possible to check off one, box, or two boxes in this section. You cannot however check off all three because it’s impossible for this to be your first CAT Application and be a reapplication for catastrophic determination at the same time. That means it can’t be your first time applying, but also your second or third time applying at the same time. That just doesn’t make sense, so be careful with this section.
The bottom of Part 1 is very important to complete. That part requires the signature of the Applicant or Substitute Decision Make, along with their name and date. The OCF-19 is NOT complete without the name, signature and date of the Applicant. Our lawyers have seen countless CAT Applications get delayed because accident victims failed to include this small, yet simple detail.
Part 2 of the OCF-19 is some basic contact information from the doctor or physician who is completing the form. This section is easy enough to complete for your doctor.
Part 3 of the OCF-19 is for your doctor to provide his/her information as to how they know, or don’t know the Applicant. Questions in this section ask:
+ Applicant is currently in my care and most recently seen on ________. Number of years in my care _______
+ Applicant was seen for the purpose of preparing an application on ________
+ Applicant was in my care but no longer actively followed. Date last seen by me ___________
+ I have reviewed the file but have not seen the Applicant. The most relevant material reviewed is dated ________
+ I have seen this person ____ time(s) for the purpose of evaluating impairment.
Part 4 of the OCF-19 is the trickiest and most technical part of the form. This part of the form sets out the medico-legal criteria to be found catastrophic pursuant to the Statutory Accident Benefits Schedule (SABS) and the Insurance Act. If you don’t meet one of these medico-legal criteria, you will not be found catastrophic. The criteria are as follows:
- Paraplegia or quadriplegia
- If the accident occurred on or after September 1, 2010, an amputation of an arm or leg or another impairment causing the total and permanent loss of use of an arm or a leg
- If the accident occurred between October 1, 2003 and August 31, 2010, amputation or other impairment causing the total and permanent loss of both arms or both legs, or one or both arms and one or both legs
- If the accident occurred between November 1, 1996 and September 30, 2003, amputation or other impairment causing the total and permanent loss of use of both arms or both an arm and a leg
- the total loss of vision in both eyes
- Brain impairment that, in respect of an accident, results in:
i) a score of 9 or less on the Glasgow Coma Scale according to a test administered within a reasonable period of time after the accident by a person trained for that purpose, or
ii) a score of 2 (vegetative) or 3 (severe disability) on the Glasgow Outcome Scale according to a test administered more than six months after the accident by a person trained for that purpose
7. An 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% or more impairment of the whole person; or
8. An impairment that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in a class 4 impairment (marked impairment) or class 5 (extreme impairment) due to mental or behavioural disorder.
Part 5 This part requires the name and signature of the doctor completing the OCF-19, along with the date the form was completed. Failure to sign and date the OCF-19 means that the form is NOT complete.
Some things to note from the OCF-19 form:
a) the medico legal criteria for Class 7 and 8 are based on an American text (the AMA Guidelines) which is outdated (4th edition from 1993!) They are now up to the 6th edition of the very same book. You can purchase the 6th Edition of the AMA Guidelines to Impairment on Amazon for under $200. The fact that our Canadian law, relies on an American text that has been surpassed by 2 editions and is over 22 years old is ludicrous. Funny enough, lawyers who keep around old text or old versions of rules are often ridiculed. As lawyers, we are taught to keep up with the state of the law and how it changes. But for catastrophic designations, we Ontarians have gone far outside our jurisdiction for a definition of catastrophic which has not been updated in 22 years. Go figure….
b) The fee for completing the OCF-19 is NOT covered by OHIP or by the Ministry of Health. The insurer will sometimes re-reimburse a doctor for completing the form, but there’s no guarantee and payment may not be as timely as you would expect.