A-25, r. 10 - Regulation respecting lump-sum compensation for non-pecuniary damage

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Full text
chapter A-25, r. 10
Regulation respecting lump-sum compensation for non-pecuniary damage
AUTOMOBILE INSURANCE - COMPENSATION - NON-PECUNIAIRY DAMAGE
Automobile Insurance Act
(chapter A-25, s. 195, par. 12)
A-25
September 1 2012
DIVISION I
GENERAL PROVISIONS
1. This Regulation applies to victims of automobile accidents that have occurred since 1 January 2000.
O.C. 1370-2000, s. 1.
2. Lump-sum compensation for non-pecuniary damage is determined in accordance with:
(1)  The provisions of Division II when the severity of the permanent functional or esthetic impairments affecting a victim correspond or is comparable to a situation described in one of the categories of severity set out in the Schedule of Permanent Functional and Esthetic Impairments (Schedule I);
(2)  The provisions of Division III when the victim has no permanent impairments or the severity of the impairments is insufficient to entitle the victim to lump-sum compensation under the provisions of Division II;
(3)  The provisions of Division IV when the victim dies.
O.C. 1370-2000, s. 2.
DIVISION II
NON-PECUNIARY DAMAGE IN THE EVENT OF PERMANENT IMPAIRMENTS
3. Any functional or esthetic impairment is considered permanent when examinations and accepted medical knowledge do not point to any significant foreseeable improvement or deterioration in the victim’s condition in the short or medium term.
O.C. 1370-2000, s. 3.
4. The evaluation of permanent impairments to functional or esthetic units must allow for the determination as warranted of functional limitations, functional restrictions, and esthetic changes affecting the victim as well as the importance of these impairments in relation to the situations described in the categories of severity provided in Schedule I. Deterioration that may occur in the long term must not be taken into consideration. In the event of such deterioration, a new evaluation will determine any increase in impairment.
The evaluation of permanent impairments must be performed in accordance with the guidelines provided in Schedule I and the result must be explainable by accepted medical knowledge supported by the objective findings found on clinical examination.
O.C. 1370-2000, s. 4.
5. The category of severity of an esthetic or functional unit impairment is determined by the situation having the maximum impact among the situations that correspond to the result of the evaluation of the permanent impairments.
When the evaluation of permanent impairments reveals situations that are not described in any of the categories of severity, they are compared to similar situations listed therein whose severity is equivalent in terms of the after-effects experienced in daily life such as loss of enjoyment of life, mental suffering, pain, and other consequences.
Only one category of severity may be assigned for each unit impairment and the percentage corresponding to that category may only be awarded once.
O.C. 1370-2000, s. 5.
6. Non-pecuniary damage is evaluated as follows:
(1)  In the event of functional impairments:
(a)  Identify the functional units listed in Schedule I that are permanently impaired;
(b)  Determine for each functional unit identified the category of severity that best represents the victim’s situation and the corresponding percentage. Any injury or illness that occurs subsequent to the accident and that is unrelated thereto is not taken into consideration;
(c)  If the case arises, determine a percentage for a bilateral impairment of the upper limbs:
i.  Identify the right and left functional units that are permanently impaired. Only the functional units “Ability to Move and Maintain the Position of Upper Limbs” and “Manual Dexterity” are taken into consideration. There must be at least one permanent impairment that is related to the accident and that is sufficiently serious to correspond to a category of severity;
ii.  Determine for each functional unit identified the category of severity that best represents the victim’s situation and the corresponding percentage. Any functional unit impairments related to the accident or present prior to the accident and sufficiently serious to correspond to a category of severity are taken into consideration. Impairments that occur subsequent to the accident and that are unrelated thereto are not taken into consideration;
iii.  Apply the following calculation method:


Sum of the % Sum of the % Retained
of the 2 of the 2 percentage for a
functional units + functional units = bilateral impairment
on the left side on the right side
___________________________________________________

8

The minimum is 0.5% and the maximum is the sum of the percentages of the 2
functional units on the least-impaired side. When the retained percentage includes
decimals, only the first is kept. When the decimal is between 1 and 4, it is
increased to 5; when it is between 6 and 9, the result is rounded up to the next
full percentage.

(d)  In cases where the victim was impaired prior to the accident
i.  Determine for each functional unit identified the category of severity that best represents the situation prior to the accident and the corresponding percentage;
ii.  Determine the percentage for the bilateral impairment to the upper limbs prior to the accident;
In each case, the retained percentage in relation to the accident is the difference between the percentage corresponding to the victim’s situation as determined by the evaluation and the percentage corresponding to the victim’s situation prior to the accident.
(2)  In the event of esthetic impairments:
(a)  Identify the esthetic units listed in Schedule I that are permanently impaired;
(b)  Determine for each esthetic unit identified the category of severity that best represents the victim’s situation in relation to the accident and the corresponding percentage.
In cases where several percentages have been calculated, an overall percentage is determined using the following method:
(1)  The highest percentage is applied to 100%:
[100%] × [the highest %] = A%;
(2)  The second highest percentage is applied to the remainder, which is the difference between 100% and the highest percentage:
[100% - A%] × [the second highest %] = B%. (If the percentage obtained has more than two decimals, only the first two are retained and the second decimal is rounded up one unit when the third is greater than 4.)
(3)  The other percentages are applied in the same way to the successive remainders, beginning with the highest:
[100% - (A% + B%)] × [the third highest %] = C%. (If the percentage obtained has more than two decimals, only the first two are retained and the second decimal is rounded up one unit when the third is greater than 4.)
(4)  The resulting percentages are then added up:
Overall % = A% + B% + C% + (…). When the result includes decimals, it is rounded up to the next full percentage.
O.C. 1370-2000, s. 6.
7. The lump-sum compensation awarded to the victim for all non-pecuniary damage is the amount obtained by multiplying the percentage calculated in accordance with section 6 by the amount of $175,000 prescribed in section 73 of the Automobile Insurance Act (chapter A-25).
O.C. 1370-2000, s. 7.
DIVISION III
NON-PECUNIARY DAMAGE IN THE EVENT OF INJURIES
8. When the victim does not suffer any permanent functional or esthetic impairment or the severity of the impairments is insufficient to entitle the victim to lump-sum compensation under the provisions of Division II, non-pecuniary damage is evaluated as follows:
(1)  Identify the injuries listed in Schedule II that the victim sustained in the accident and determine their corresponding severity rating. For any injury not listed, assign the severity rating corresponding to a similar injury of equivalent severity;
(2)  Determine the injury with the highest severity rating for each of the titles indicated in Schedule II;
(3)  Add the square of the highest severity ratings among those previously identified up to a maximum of three ratings;
(4)  Determine the category of severity using Table I;
The amount of lump-sum compensation awarded to the victim is the sum indicated in Table I for the corresponding category of severity determined. Category of severity b is the minimum required for compensation.
Table I


Result of Addition Category of Severity Amount of Compensation


1 to 8 a $0


9 to 15 b $300


16 to 24 c $500


25 to 35 d $800


36 and over e $1,000

O.C. 1370-2000, s. 8.
DIVISION IV
NON-PECUNIARY DAMAGE IN THE EVENT OF DEATH
9. In the event of the death of the victim, lump-sum compensation for non-pecuniary damage is determined in accordance with:
(1)  The provisions of Division II when the victim dies more than 12 months after the accident and permanent impairments sufficiently serious to correspond to a category of severity were medically foreseeable. Compensation is calculated on the basis of the impairments that the victim would have probably suffered on a permanent basis;
(2)  The provisions of Division III:
(a)  When the victim dies more than 24 hours after the accident but within 12 months thereof;
(b)  When the victim dies more than 12 months after the accident and it was medically foreseeable that no permanent functional or esthetic impairment would have been suffered or that the severity of the impairments would have been insufficient to entitle the victim to lump-sum compensation under the provisions of Division II.
O.C. 1370-2000, s. 9.
DIVISION V
FINAL PROVISIONS
10. This Regulation replaces the Regulation respecting lump-sum compensation for non-pecuniary damage (O.C. 1333-99, 99-12-01).
O.C. 1370-2000, s. 10.
11. (Omitted).
O.C. 1370-2000, s. 11.
SCHEDULE I
(ss. 2, 4 and 6)
SCHEDULE OF PERMANENT FUNCTIONAL AND ESTHETIC IMPAIRMENTS
FUNCTIONAL UNITS
(1) Mental function
(2) State of consciousness
(3) Cognitive aspect of language
(4) The functions of the visual system are composed of 2 units:
(4.1) Vision
(4.2) Ancillary functions of the visual system
(5) The functions of the auditory system are composed of 2 units:
(5.1) Hearing
(5.2) Ancillary functions of the auditory system
(6) Taste and smell
(7) Skin sensitivity is composed of 7 units:
(7.1) Skin sensitivity of the skull and face
(7.2) Skin sensitivity of the neck
(7.3) Skin sensitivity of the trunk and genital organs
(7.4) Skin sensitivity of the right upper limb
(7.5) Skin sensitivity of the left upper limb
(7.6) Skin sensitivity of the right lower limb
(7.7) Skin sensitivity of the left lower limb
(8) Clinical pictures of balance disorders
(9) Phonation
(10) Mimic
(11) Ability to move and maintain the position of head
(12) Ability to move and maintain the position of trunk
(13) Ability to move and maintain the position of upper limbs is composed of 2 units:
(13.1) Ability to move and maintain the position of right upper limb
(13.2) Ability to move and maintain the position of left upper limb
(14) Manual dexterity (prehension and manipulation) is composed of 2 units:
(14.1) Right manual dexterity
(14.2) Left manual dexterity
(15) Locomotion
(16) Protection provided by the skull
(17) Protection provided by the rib cage and abdominal wall
(18) Nasopharyngeal respiration
(19) The digestive functions are composed of 4 units:
(19.1) Ingestion (chewing and swallowing including prehension and salivation)
(19.2) Digestion and absorption
(19.3) Excretion
(19.4) Hepatic and biliary functions
(20) Cardio-respiratory function
(21) The urinary functions are composed of 2 units:
(21.1) The renal function
(21.2) Micturition
(22) The genito-sexual functions are composed of 3 units:
(22.1) Genital Sexual Activity
(22.2) Procreation
(22.3) Termination of Pregnancy
(23) Endocrine, hematological, immune, and metabolic functions
(24) Clinical pictures of paraplegia and quadriplegia
ESTHETIC UNITS
(25) There are eight esthetic units:
(25.1) Esthetic of the skull and scalp
(25.2) Esthetic of the face
(25.3) Esthetic of the neck
(25.4) Esthetic of the trunk and genital organs
(25.5) Esthetic of the right upper limb
(25.6) Esthetic of the left upper limb
(25.7) Esthetic of the right lower limb
(25.8) Esthetic of the left lower limb
(1) THE MENTAL FUNCTION
The various dimensions of the mental function have an impact on all activities of daily living.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Evaluation must take into account the following criteria for determining the overall impact of an impairment of the mental function on daily life:
— The degree of independence and social functioning evaluated on the basis of the need to turn to compensating strategies, technical aids, or human surveillance and/or assistance
— The importance of the impact of a cognitive disorder on the performance of activities of daily living
— The importance of the impact of affective or mental disorders on the performance of activities of daily living evaluated using the “Global Assessment of Functioning Scale” proposed by the American Psychiatric Association.
GLOBAL ASSESSMENT OF FUNCTIONING (GAF)*


100 |
| Superior functioning in a wide range of activities, life’s problems never
| seem to get out of hand, is sought out by others because of his or her many
| positive qualities. No symptoms.
91 |

90 |
| Absent or minimal symptoms (e.g., mild anxiety before an exam), good
| functioning in all areas, interested and involved in a wide range of
| activities, socially effective, generally satisfied with life, no more than
| everyday problems or concerns (e.g., an occasional argument with family
| members).
81 |

80 |
| If symptoms are present, they are transient and expectable reactions to
| psychosocial stressors (e.g., difficulty concentrating after family
| argument), no more than slight impairment in social, occupational, or school
| functioning (e.g., temporarily falling behind in schoolwork).
71 |

70 |
| Some mild symptoms (e.g., depressed mood and mild insomnia) OR some
| difficulty in social, occupational, or school functioning (e.g., occasional
| truancy, or theft within the household), but generally functioning pretty
| well, has some meaningful interpersonal relationships.
61 |

60 |
| Moderate symptoms (e.g., flat affect and circumstantial speech, occasional
| panic attacks) OR moderate difficulty in social, occupational, or school
| functioning (e.g., few friends, conflicts with peers or co-workers).
51 |

50 |
| Serious symptoms (e.g., suicidal ideation, several obsessional rituals,
| frequent shoplifting) OR any serious impairment to social, occupational, or
| school functioning (e.g., no friends, unable to keep a job).
41 |

40 |
| Some impairment in reality testing or communication (e.g., speech is
| sometimes illogical, obscure, or irrelevant) OR major impairment in several
| areas, such as work or school, family relations, judgment, thinking, or mood
| (e.g., depressed man avoids friends, neglects family, and is unable to work;
| child frequently beats up younger children, is defiant at home, and is
| failing at school).
31 |

30 |
| Behaviour is considerably influenced by delusions or hallucinations OR serious
| impairment in communication or judgment (e.g., sometimes incoherent, acts
| grossly inappropriately, suicidal preoccupation) OR inability to function in
| almost all areas (e.g., stays in bed all day; no job, home, or friends).
21 |

20 |
| Some danger of hurting self or others (e.g., suicide attempts without clear
| expectation of death; frequently violent; manic excitement) OR occasionally
| fails to maintain minimal personal hygiene (e.g., smears feces) OR gross
| impairment in communication (e.g., largely incoherent or mute).
11 |

10 |
| Persistent danger of severely hurting self or others (e.g., recurrent
| violence) OR persistent inability to maintain minimal personal hygiene OR
| serious suicidal act with clear expectation of death.
1 |

* American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th Edition, Washington, DC, 1994, p. 32
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE If symptoms are present, they have no significant impact on
MINIMUM personal and social functioning. The after-effects of the permanent
THRESHOLD impairment are less than those that would result from the
situations described for category of severity 1.


Affective or mental disorders that affect personal and social
functioning and that are between 71 and 80 on the Global Assessment
SEVERITY 1 of Functioning Scale”;
2%
or Regular and permanent need to take prescription medication that may
cause side effects.


Affective or mental disorders that affect personal and social
functioning and that are between 61 and 70 on the Global
Assessment of Functioning Scale”;
SEVERITY 2
5% or Minor cognitive impairment such as shorter attention span while
performing complex tasks, occasionally combined with fatigability.
The difficulties experienced require slight changes in the
organization of activities.


Affective or mental disorders that affect personal and social
functioning and that are between 51 and 60 on the Global
Assessment of Functioning Scale”;

or Slight cognitive impairment such as attention, memory, or learning
SEVERITY 3 difficulties, occasionally combined with fatigability. The
15% impairment is severe enough to affect the organization and
performance of complex tasks such as making important decisions.

The difficulties experienced require significant changes in the
organization of activities and may necessitate human surveillance
or assistance.


Affective or mental disorders that affect personal and social
functioning and that are between 41 and 50 on the Global
Assessment of Functioning Scale”;

or Moderate cognitive impairment such as attention, memory or learning
SEVERITY 4 difficulties, or reduced judgment, often combined with
35% fatigability. The impairment is severe enough to affect the
performance of routine tasks such as the planning of daily domestic
activities (meals, housework, purchases).

The difficulties experienced require a reorganization in the
organization of activities and necessitate human surveillance or
assistance.


Affective or mental disorders with major disruption of personal and
social functioning, altered sense of reality;
SEVERITY 5
70% or Cognitive impairment severe enough to prevent the performance of
simple routine tasks. The person can only be left alone for short
periods.


The person is totally or almost totally dependent on human
assistance for the performance of most activities of daily living.
SEVERITY 6
100% Protective measures may be necessary such as a protected
environment, confinement, restraint.

(2) STATE OF CONSCIOUSNESS
Consciousness is the faculty that makes a person aware and able to judge his or her own reality. Permanent impairments to the state of consciousness can show up as episodic disorders such as epilepsy, lipothymia, or fainting, or as ongoing disorders such as stupor, coma, or a chronic vegetative state.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Impacts on other functional units, such as incontinence during an epileptic seizure, are taken into account in this unit.
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situation described in Severity 1.
THRESHOLD


Disturbances to the state of consciousness that slightly interfere
SEVERITY 1 with daily activities medication, which may have possible side
5% effects, is necessary to keep conditions such as epilepsy under
control. Response to medical treatment is adequate and sufficient to
allow the patient to drive a car.


Disturbances to the state of consciousness that moderately interfere
SEVERITY 2 with daily activities. Response to medical treatment is sufficient
15% to allow the patient to remain independent but not to perform tasks
that could endanger his or her safety or that of others, such as
driving a car.


Disturbances to the state of consciousness that significantly
interfere with daily activities. The severity of the seizures in
SEVERITY 3 terms of their intensity (type), frequency despite medication, and
30% circumstances (trigger, timing) justifies the regular intervention
of another person (surveillance or assistance).
However, the patient remains sufficiently independent to retain a
certain level of social interaction.


SEVERITY 4 Impairments to the state of consciousness that severely interfere
60% with daily activities.
Autonomy and social interactions are reduced to a minimum.


SEVERITY 5 Total absence of interpersonal relationships, such as in a chronic
100% vegetative state, making the person completely dependent on another
person and on medical support.


(3) COGNITIVE ASPECT OF LANGUAGE
The cognitive aspect of language refers to the mental ability to understand and produce oral and written language. Examples of impairments include dysphasia, aphasia, alexia, agraphia and acalculia.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) The evaluation must take into account the following abilities in order to determine the overall impact on daily life:
— Expressing oneself in speech
— Expressing oneself in writing
— Expressing oneself with gestures or expressions
— Naming or describing objects
— Spelling
— Understanding verbal and nonverbal language
— Reading with understanding
— Understanding spoken or written directions
— Repeating
Depending on the circumstances, the evaluation of functional impairments may be documented using any other relevant examination.
(3) Peripheral sensory or motor impairments that may interfere with understanding and/or the mechanical expression of language must not be evaluated using the rules provided under this unit but using the rules provided in the functional units that specifically deal with the observed impacts.
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental suffering, pain,
and other consequences - resulting from a permanent impairment can be compared with those that would result from the situation with maximum impact among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situation described in Severity 1.
THRESHOLD


SEVERITY 1 Occasional trouble with word recall in written or spoken language.
5%


Frequent word substitutions or deformations (paraphasia),
SEVERITY 2
20% or Difficulty in understanding long, complex sentences or abstract or
figurative language.


SEVERITY 3 Serious difficulty with writing (dysgraphia);
40%
or Difficulty in understanding simple sentences.


SEVERITY 4 Major problems in understanding combined with difficulties with
70% expression that make conversation very arduous.


SEVERITY 5 Understanding is virtually or totally nonexistent and the person is
100% completely incapable of expressing thoughts in language.


(4) FUNCTIONS OF THE VISUAL SYSTEM
The function of the visual system is to put people in contact with the outside world by means of light.
The functions of the visual system are composed of 2 functional units.
(4.1) Vision
(4.2) Ancillary Functions of the Visual System
— Protection
— Eye lubrication
— Light sensitivity, photophobia, accommodation, convergence, colour perception, etc
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Reading difficulties related to a cognitive impairment must not be evaluated using to the rules provided in this unit but using the rules provided in the functional unit “Cognitive Aspect of Language”.
(3) Specific guidelines are given at the beginning of each functional unit.
(4.1) VISION
Specific Guidelines
The evaluation is conducted in 4 steps.
STEP 1: Evaluation of the 3 components required for optimal vision
(A) Procedure to determine the retained percentages of central visual acuity for distance and close-up vision
· Central visual acuity is measured for each eye using the best optical correction that can be comfortably tolerated and that is acceptable for distance and close-up vision.
· The retained percentage of visual acuity for each eye, which is entered on the form for calculating the efficiency percentage for each eye in Step 2, is obtained using the following table:
RETAINED PERCENTAGE OF CENTRAL VISUAL ACUITY
Distance
Vision Close-up
(meters) Vision 0.4M 0.5M 0.6M 0.8M 1M 1.25M 1.6M 2M 2.5M 3.2M 4M

__________________________________________________________________________
|
6/4.5 | 100* 100 97 95 75 70 60 57 55 52 51
| 50** 50 48 47 37 35 30 28 27 26 25
| _________________________________________________________________
|
6/6 | 100 100 97 95 75 70 60 57 54 52 51
| 50 50 48 47 37 35 30 28 27 26 25
| _________________________________________________________________
|
6/7.5 | 97 97 95 92 72 67 57 55 52 50 48
| 48 48 47 46 36 33 28 27 26 25 24
| _________________________________________________________________
|
6/9 | 95 95 92 90 70 65 55 52 50 47 46
| 47 47 46 45 35 32 27 26 25 24 23
| _________________________________________________________________
|
6/12 | 92 92 90 87 67 62 52 50 47 45 43
| 46 46 45 43 33 31 26 25 23 22 21
| _________________________________________________________________
|
6/15 | 87 87 85 82 62 57 47 45 42 40 38
| 43 43 42 41 31 28 23 22 21 20 19
| _________________________________________________________________
|
6/18 | 84 84 82 78 59 54 44 41 39 36 35
| 42 42 41 39 30 27 22 21 19 18 17
| _________________________________________________________________
|
6/21 | 82 82 79 77 57 52 42 39 37 35 33
| 41 41 39 38 28 26 21 21 18 17 16
| _________________________________________________________________
|
6/24 | 80 80 77 75 55 50 40 37 35 32 31
| 40 40 38 37 27 25 20 18 17 16 15
| _________________________________________________________________
|
6/30 | 75 75 72 70 50 45 35 32 30 27 26
| 37 37 36 35 25 22 17 16 15 13 13
| _________________________________________________________________
|
6/36 | 70 70 67 65 45 40 30 27 25 22 21
| 35 35 33 32 22 20 15 13 12 11 10
| _________________________________________________________________
|
6/45 | 66 66 63 61 41 36 26 23 21 18 17
| 33 33 32 30 20 18 13 12 10 9 8
| _________________________________________________________________
|
6/60 | 60 60 57 55 35 30 20 17 15 12 11
| 30 30 28 27 17 15 10 9 7 6 5
| _________________________________________________________________
|
6/90 | 57 57 55 52 32 27 17 15 12 10 8
| 38 38 27 26 16 13 9 7 6 5 4
| _________________________________________________________________
|
6/120 | 55 55 52 50 30 25 15 12 10 7 6
| 27 27 26 25 15 12 7 6 5 3 3
| _________________________________________________________________

6/240 | 52 52 50 47 27 22 12 10 7 5 3
| 26 26 25 23 13 11 6 5 3 2 1

* Upper value: retained percentage of central visual acuity in the absence of monocular aphakia
** Lower value: retained percentage of central visual acuity with allowance for monocular aphakia
(B) Procedure to determine the retained percentage of the visual field for each eye
· The extent of the visual field is determined using the usual perimetric methods. The conventional standard is the III-4e kinetic stimulus of the Goldman perimeter. The IV-4e stimulus should be used with a person with an aphakic eye corrected with prescription glasses and not contact lenses.
· The index finger or target is brought from the periphery to the visual field, i.e., from the unseen to the seen. The peripheral field is measured for each meridian. If the measurement differs from the clinical result, a second measurement that agrees with the first within 15° should be obtained. The result is recorded on an ordinary visual field chart for each of the eight principal meridians separated from one another by 45°. The meridians and the normal extent of the visual field from the point of fixation are recorded on the visual field chart shown in Diagram 1.
Where there is a deficit in a quadrant or a half field, or any other anomaly, the measurement will be the average of the values for the two adjacent meridians.
· The retained percentage of the visual field, which is entered on the form for calculating the percentage of visual efficiency of each eye in Step 2, is obtained using the following formula:
Total retained degrees *
_____________________________________
Number of degrees prior to the accident ** × 100 = retained % of visual field
* Sum of retained degrees for the eight principal meridians shown in Diagram 1 (for the III-4e isopter)
** The extent of the visual field prior to the accident can vary depending on the person and on age. For the impaired eye, the extent of the visual field prior to the accident is determined by comparison with the other eye, if it is healthy. Where the contra lateral eye is not healthy, the normal value is presumed to be 500.
DIAGRAM 1
VISUAL FIELDS
LEFT EYE RIGHT EYE
(C) Procedure to determine the retained percentage of ocular motility
· The extent of the diplopia when the person looks in various directions is determined using the best correction possible (prism) comfortably tolerated and that is acceptable, but without coloured lenses.
· The evaluation is conducted using a small test light or Goldman perimeter III-4e stimulus at 330 mm or any campimeter at 1 m from the eye of the person.
· Results for image separation when the person looks in various directions are recorded on a visual field chart (Diagram 2) for each of the eight principal meridians.
· In the case of an impairment outside the central 20°, total percentage loss of ocular motility is calculated by adding the percentages of loss indicated in Diagram 2 corresponding to the separation of the 2 images as evaluated by the examination, up to a maximum of 92%.
· In the case of an impairment inside the central 20°, total percentage loss of ocular motility corresponds to the maximum of 92%.
· The retained percentage of ocular motility entered on the form to calculate the efficiency percentage of each eye in Step 2 is obtained by subtracting the percentage of loss from 100%. The result is applied to the eye with the greatest impairment. The other eye is attributed a normal value, i.e., 100%.
· Loss of ocular motility
· Inside the central 20° equals 92%
· Outside the central 20° equals the sum of the percentages up to a maximum of 92% for the meridians where a separation of images has been noted
STEP 2: Determination of the Percentage of Efficiency of Each Eye


Retained %* Retained %* Retained %* % of Efficiency
of Visual of Visual of Ocular of Eye
Acuity Field Mobility**


Right Eye ____________ X ____________ X _______________ = _______________

Left Eye ____________ X ____________ X _______________ = ______________
* The retained percentages are those noted in the examination of the 3 components and calculated in Step 1.
** For calculation purposes, the retained percentage of ocular motility calculated in Step 1 is only applied to the most seriously impaired eye. The other eye is assigned an ocular motility value of 100%.

STEP 3: Determination of the Percentage of Visual Efficiency


% of Efficiency* % of Efficiency* % of Efficiency
of Better Eye of Other Eye of Vision

( X 3 ) + =
__________________________________________________ ___________________
4
* The efficiency percentages for each eye are those obtained in Step 2.

STEP 4: Determination of the Percentage of Functional Loss of Vision


Normal Vision % of Efficiency % of Functional Loss
of Vision* of Vision

100% - __________________ = _________________________
* The vision efficiency percentage is that obtained in Step 3.

For compensation purposes, the category of severity corresponds to the percentage of functional loss of vision. The result is rounded up to the nearest 0.5% or higher unit, with a maximum of 85%.
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situation described in Severity 0.5.
THRESHOLD


Inconvenience due to wearing a corrective device to provide normal
SEVERITY 0.5 vision Compensation in this category of severity is only awarded if
0.5% the person was not wearing a corrective device prior to the
accident.


Inconvenience due to a permanent impairment to vision that cannot be
fully corrected with a corrective device (glasses, prisms, contact
SEVERITY lenses).
1 TO 85
The category of severity corresponds to the extent of functional
1 TO 85% loss of vision as determined by an ophthalmologic evaluation. It
varies from 1 to a maximum of 85.

(4.2) ANCILLARY FUNCTIONS OF THE VISUAL SYSTEM
Specific Guidelines
(1) Loss of accommodation and photophobia experienced by a person with an aphakic eye are already included in the visual acuity calculation in Step 1A of 4.1. (see Retained Percentage of Central Visual Acuity) and are not eligible for a category of severity in this section.
(2) Fusion anomalies and convergence insufficiencies experienced by a person diagnosed with ocular motility impairments are already included in the ocular motility calculation in Step 1C of 4.1. and are not eligible for a category of severity in this section.
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situations described in Severity 1.
THRESHOLD


Slight photosensitivity or photophobia requiring, among other
things, the wearing of sunglasses, such as with maculopathy, or
corneal, pupillary or ocular media impairment,

or Slight loss of accommodation;

or colour vision disorder;

SEVERIY 1 or Slight fusion anomaly or slight paralysis of convergence, such as
1% with decompensated, nonreducible, and occasionally symptomatic
anterior heterophoria;

or Slight unilateral or bilateral intermittent lacrimation;

or Slight palpebral ptosis;

or Justification for therapeutic measures resulting in minor
inconvenience such as having to take regular medication.


Moderate photophobia that requires, among other things, the wearing
of sunglasses, such as with maculopathy, or corneal, pupillary, or
ocular media impairment;

or Moderate or significant loss of unilateral or bilateral
accommodation;

or Moderate fusion anomaly or moderate paralysis of convergence, such
as with decompensated, nonreducible, and daily symptomatic anterior
SEVERITY 2 heterophoria;
3%
or Paralysis of conjugate upward gaze;

or Frequent unilateral or bilateral lacrimation;

or Marked palpebral ptosis;

or Superficial punctate keratitis.


Significant photophobia, such as with nonreactive mydriasis;

or Complete paralysis of accommodation in one eye, such as with
pseudophakia;
SEVERITY 3
5% or Lacrimation caused by complete stenosis of one inferior caniculus;

or Moderate keratitis requiring frequent lubrication.


Maximum photophobia, such as with the loss of the iris;

or Complete paralysis of accommodation in both eyes;

or Complete paralysis of convergence;

SEVERITY 4 or Paralysis of conjugate downward or lateral gaze;
10%
or Severe and persistent unilateral or bilateral keratitis despite
treatment;

or Lacrimation caused by complete stenosis of the inferior caniculi of
both eyes.

(5) FUNCTIONS OF THE AUDITORY SYSTEM
The function of the auditory system is to put people in contact with the outside world by means of sound (words, music, background noise, etc.).
The functions of the auditory system are composed of 2 functional units.
(5.1) Hearing
(5.2) Ancillary Functions of the Auditory System
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Balance disorders and understanding difficulties related to a cognitive disorder must not be evaluated using the rules provided in this unit but using the rules provided in the functional units “Clinical Pictures of Balance Disorders” and “Cognitive Aspect of Language”.
(3) Specific guidelines for evaluating auditory impairments are given at the beginning of 5.1.
(5.1) HEARING
Specific Guidelines
The evaluation is conducted in 3 steps:
STEP 1: Determination of the average hearing threshold for each ear (tonal audiometry) and of the factor of severity of the binaural impairment
(A) Determination of the average hearing threshold for each ear (tonal audiometry)
The hearing threshold for each ear is evaluated by tonal audiometry without a hearing aid. The frequencies used are 500, 1,000, 2,000, and 4,000 hertz (Hz).
For calculation purposes, the maximum hearing threshold for a given frequency is set at 100 dB.
The average hearing threshold for each ear is obtained using the calculation method given below. For results above 25 dB, the average hearing threshold is rounded up or down to the nearest multiple of 5.
CALCULATION OF AVERAGE HEARING THRESHOLDS
___________________________________________________________________________________
| |
500 Hz 1,000 Hz 2,000 Hz 4,000 Hz | Average Hearing | Rounded
| Threshold | Average
| | (dB)
Right | |
Ear ________+________+________+________= | _________÷ 4 = ________ | → _______
| |
Left | |
Ear ________+________+________+________= | _________÷ 4 = ________ | → _______

___________________________________________________________________________________
(B) Determination of the factor of severity of the binaural impairment
The rounded averages obtained for each ear are entered in the table below to obtain the factor of severity.
The rounded average for a given ear must be 25 dB or more to entitle a person to compensation.
FACTORS OF SEVERITY FOR BINAURAL IMPAIRMENT
Rounded
Average
(dB)
for
Each
Ear <25 25 30 35 40 45 50 55 60 65 ≥70



<25 NA 0.5 0.5 1 1.5 2.5 4.5 6.5 8 8.5 9


25 0.5 1.5 1.5 2 2.5 3.5 5.5 7.5 9 9.5 10


30 0.5 1.5 3 3.5 4 5 7 9 10.5 11 11.5


35 1 2 3.5 6 6.5 7.5 9.5 11.5 13 13.5 14


40 1.5 2.5 4 6.5 9 10 12 14 15.5 16 16.5


45 2.5 3.5 5 7.5 10 15 17 19 20.5 21 21.5


50 4.5 5.5 7 9.5 12 17 27 29 30.5 31 31.5


55 6.5 7.5 9 11.5 14 19 29 39 40.5 41 41.5


60 8 9 10.5 13 15.5 20.5 30.5 40.5 48 48.5 49


65 8.5 9.5 11 13.5 16 21 31 41 48.5 51 51.5


≥70 9 10 11.5 14 16.5 21.5 31.5 41.5 49 51.5 54

STEP 2: Determination of auditory discrimination for each ear (vocal audiometry) and of the adjustment factor
The percentages of auditory discrimination for each ear are obtained by vocal audiometry and entered in the table below to obtain the adjustment factor.
ADJUSTMENT FACTOR


% of Auditory Discrimination
for Each Ear 90 to 100 70 to 89 50 to 69 <50



90 to 100 0 1 2 3


70 to 89 1 2 3 4


50 to 69 2 3 4 5


<50 3 4 5 6

STEP 3: Determination of the category of severity
The category of severity for auditory impairment is the sum of the factor of severity from Step 1 and the adjustment factor from Step 2.


Factor of Severity Adjustment Factor
(Step 1) (Step 2) Category of Severity



______________________ + _________________________ = ______________________

CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situation described in Severity 0.5.
THRESHOLD


SEVERITY Inconvenience due to a permanent hearing loss.
0.5 TO 60
The category of severity corresponds to the extent of functional
0.5 TO 60% hearing loss determined by an audiological evaluation. It varies
from 0.5 to a maximum of 60.


(5.2) ANCILLARY FUNCTIONS OF THE AUDITORY SYSTEM
CATEGORIES OF SEVERITY


Inconveniences experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situations described in Severity 1.
THRESHOLD


Frequent or intense tinnitus* but with no significant effect on
sleep;
SEVERITY 1
2% or Medical necessity for preventive, palliative, or therapeutic
measures that cause inconvenience, such as swimming forbidden
because of a tympanic perforation.


Recurring otorrhea due to tympanic perforation;

SEVERITY 2 or Frequent irritation and infections, such as with external auditory
3% canal stenosis;

or Frequent, episodic exacerbations, such as with cholesteatoma.


SEVERITY 3 Tinnitus* sufficiently frequent and intense to compromise sleep on a
5% regular basis.


* Tinnitus being a subjective phenomena, it is considered for compensation purposes only if its occurrence, intensity and consequences have regularly been documented since the accident.
(6) TASTE AND SMELL
Taste is the sensory function that provides people with information on the physical and chemical characteristics of food. It allows them to determine what is sweet, salty, bitter, or sour.
Smell is the sensory function that lets people distinguish odours. It determines whether odours are pleasant or unpleasant and helps people appreciate the flavour of food. In conjunction with the trigeminal system, it also provides a protection function by detecting potentially dangerous chemical substances.
Since they are closely related, taste and smell are considered as a single functional unit.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Evaluating taste includes semi-objective chemical testing of the 4 basic sensations: sweet, salty, bitter, and sour.
(3) Evaluating smell includes subjective sniff tests complemented by the following semi-objective methods:
— Verification of the olfacto-respiratory reflex by testing the reaction to strong odours that normally cause reflex blockage of inhalation
— Verification of trigeminal sensitivity by testing the reaction to irritating substances (vinegar, ammonia)
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following situations:



UNDER THE After-effects of the permanent impairment, such as partial loss of
MINIMUM taste or smell, are less than those resulting from the situation
THRESHOLD described in Severity 1.


SEVERITY 1 Perception of unpleasant or inappropriate taste or odours
3% (dysgueusia, cacosmia, parosmia) that may interfere with daily
activities.


SEVERITY 2 Total loss of one of both functions with partial or total retention
5% of the other.


SEVERITY 3
10% Total loss of both functions: taste and smell.


(7) SKIN SENSITIVITY
Skin sensitivity is the sensory function that puts people in contact with the outside world through skin contact. It allows them to explore the outside world and react to changes in the environment (warning and protection function).
Skin sensitivity is composed of 7 functional units, each representing a separate region of the body:
(7.1) Skin Sensitivity of Skull and Face
(7.2) Skin Sensitivity of Neck
(7.3) Skin Sensitivity of Trunk and Genital Organs
(7.4) Skin Sensitivity of Right Upper Limb
(7.5) Skin Sensitivity of Left Upper Limb
(7.6) Skin Sensitivity of Right Lower Limb
(7.7) Skin Sensitivity of Left Lower Limb
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Skin sensitivity impairment resulting from paraplegia or quadriplegia must not be evaluated using the rules provided in this chapter but using to the rules provided in the functional unit “Clinical Pictures of Paraplegia and Quadriplegia”.
(3) The anatomical boundaries used to separate contiguous parts of the body are the following:
▸▸ Skull
Region inside the normal, usual hairline. In the presence of baldness, the anatomical boundary corresponds to what would have been the normal hairline.
▸▸ Face
Region defined by the anatomical boundaries of the skull and neck.
Lips area: Upper boundary is the base of the nose defined by the alae of the nose and the columella.
Lateral boundaries are the nasolabial creases
Lower boundary is the labiomental crease
▸▸ Neck
Upper boundary: line following the lower part of the body of the mandible, continuing along the vertical rami to the temporomandibular joints and then along the normal usual hairline
Lower boundary: line beginning at the jugular notch, continuing along the upper edge of the clavicle to the mid-point and then to the C7 spinous process
▸▸ Trunk and Genital Organs
Region defined by the anatomical boundaries of the neck, upper limbs, and lower limbs
▸▸ Upper Limb (upper boundary)
Circular line beginning at the apex of the armpit, extending backwards and forwards, and ending at the mid-point of the clavicle
▸▸ Lower Limb (upper boundary)
Line beginning at the median upper edge of the pubic symphysis, continuing obliquely to the antero-superior iliac spine, then along the upper edge of the iliac crest, and ending at the upper vertical boundary of the gluteal fold
(7.1) SKIN SENSITIVITY OF SKULL AND FACE
(Including the buccal cavity, the gums, and the teeth)
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as a sensitivity
MINIMUM impairment affecting an area of skin under 1 cm2 on the skull or the
THRESHOLD face (not including lips area), are less than those resulting from
the situation described in Severity 1.


Sensitivity impairment affecting an area:

for the entire skull and face: between 1 and 25 cm2;

SEVERITY 1 or for the face: between 1 and 5 cm2;
1%
or for the lips area between: less than 1 cm2;

or corresponding to one subdivision of the principal branches* of a
trigeminal nerve


Sensitivity impairment affecting an area:

for the entire skull and face: more than 25 cm2;

SEVERITY 2 or for the face: greater than 5 cm2 up to 15 cm2;
3%
or for the lips area: between 1 and 5 cm2;

or corresponding to 2 subdivisions of the principal branches* of a
trigeminal nerve


Sensitivity impairment affecting an area:

for the face: greater than 15 cm2 up to 25% of the entire surface;
SEVERITY 3
6% or for the lips area: greater than 5 cm2 up to 10 cm2;

or corresponding to more than 2 subdivisions of the principal
branches* of a trigeminal nerve


Sensitivity impairment affecting an area:

SEVERITY 4 for the face: between 25% and 50% of the entire surface;
10%
or for the lips area: greater than 10 cm2;

or corresponding to a unilateral impairment of an entire trigeminal
nerve


SEVERITY 4=5 Sensitivity impairment affecting an area greater than 50% of the
20% entire surface of the face.


* The 3 principal branches of the trigeminal nerve are the ophthalmic, maxillary, and mandibular divisions.
(7.2) SKIN SENSITIVITY OF NECK
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as a sensitivity
MINIMUM impairment affecting an area of skin under 2 cm2, are less than
THRESHOLD those resulting from the situation described in Severity 1.


SEVERITY 1 Sensitivity impairment affecting an area of skin equal to
1% approximately 2 cm2 to 10 cm2.


SEVERITY 2 Sensitivity impairment affecting an area of skin equal to
2% approximately 10 cm2 to 25 cm2.


SEVERITY 3 Sensitivity impairment affecting an area of skin equal to
3% approximately 25 cm2 or more up to 50% of the entire neck surface.


SEVERITY 4 Sensitivity impairment affecting an area of skin greater than 50% of
5% the entire neck surface.


(7.3) SKIN SENSITIVITY OF TRUNK AND GENITAL ORGANS
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental suffering,
pain, and other consequences - resulting from a permanent impairment can be compared
with those that would result from the situation with maximum impact among the following:



UNDER THE After-effects of the permanent impairment, such as a sensitivity
MINIMUM impairment affecting an area of skin under 5 cm2 on the trunk or
THRESHOLD under 2 cm2 on the breasts (only applies to women) or genital
organs, are less than those resulting from the situations described
in Severity 1.


Sensitivity impairment affecting an area of skin approximately equal
to
SEVERITY 1
1% 5 cm2 to 25 cm2 on the trunk, not including the breasts (only
applies to women) and genital organs;

or 2 cm2 to 5 cm2 on the breasts (only applies to women) or genital
organs.


Sensitivity impairment affecting an area of skin approximately equal
to
SEVERITY 2
2% 25 cm2 to 100 cm2 on the trunk, not including the breasts (only
applies to women) and genital organs;

or 5 cm2 to 25 cm2 on the breasts (only applies to women) or genital
organs.


Sensitivity impairment affecting an area of skin

SEVERITY 3 approximately equal to 100 cm2 or more up to 25% of the entire
4% surface of the trunk, not including the breasts (only applies to
women) and genital organs;

or greater than 25 cm2 on the breasts (only applies to women) or
genital organs.


SEVERITY 4 Sensitivity impairment affecting an area of skin approximately equal
7% to 25% to 50% of the entire surface of the trunk.


SEVERITY 5 Sensitivity impairment affecting an area of skin greater than 50% of
10% the entire surface of the trunk.


(7.4) SKIN SENSITIVITY OF RIGHT UPPER LIMB
(7.5) SKIN SENSITIVITY OF LEFT UPPER LIMB
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as a sensitivity
MINIMUM impairment affecting an area of skin under 5 cm2 on the upper limb
THRESHOLD or under 1 cm2 on the hand, are less than those resulting from the
situations described in Severity 1.


Sensitivity impairment affecting an area of skin approximately equal
to
SEVERITY 1
1% 5 cm2 to 25 cm2 on the upper limb, not including the hand;

or 1 cm2 to 5 cm2 on the hand.


Sensitivity impairment affecting an area of skin approximately equal
to
SEVERITY 2
3% 25 cm2 or more up to 25% of the entire surface of the upper limb,
not including the hand;

or 5 cm2 or more up to 25% of the entire surface of the hand.


Sensitivity impairment affecting an area of skin approximately equal
to
SEVERITY 3
5% 25% to 50% of the entire surface of the upper limb, not including
the hand;

or 25% to 50% of the entire surface of the hand.


Sensitivity impairment affecting an area of skin

SEVERITY 4 greater than 50% of the entire surface of the upper limb, not
8% including the hand;

or greater than 50% of the entire surface of the hand.


SEVERITY 5 Sensitivity impairment affecting an area of skin greater than 50% of
10% the entire surface of the palm.


(7.6) SKIN SENSITIVITY OF RIGHT LOWER LIMB
(7.7) SKIN SENSITIVITY OF LEFT LOWER LIMB
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental suffering,
pain, and other consequences - resulting from a permanent impairment can be compared
with those that would result from the situation with maximum impact among the following:



UNDER THE After-effects of the permanent impairment, such as a sensitivity
MINIMUM impairment affecting an area of skin under 5 cm2 on the lower limb
THRESHOLD or under 2 cm2 on the sole of the foot, are less than those
resulting from the situations described in Severity 1.


Sensitivity impairment affecting an area of skin approximately equal
to
SEVERITY 1
1% 5 cm2 to 25 cm2 on the lower limb, not including the sole of the
foot;

or 2 cm2 to 5 cm2 on the sole of the foot.


Sensitivity impairment affecting an area of skin approximately equal
to
SEVERITY 2
2% 25 cm2 to 100 cm2 on the lower limb, not including the sole of the
foot;

or 5 cm2 to 10 cm2 on the sole of the foot.


Sensitivity impairment affecting an area of skin

SEVERITY 3 greater than 100 cm2 but less than 25% of the entire surface of the
4% lower limb, not including the sole of the foot;

or greater than 10 cm2 but less than 50% of the entire surface of the
sole of the foot.


Sensitivity impairment affecting an area of skin approximately equal
to
SEVERITY 4
6% 25% to 50% of the entire surface of the lower limb, not including
the sole of the foot;

or 50% or more of the entire surface of the sole of the foot.


SEVERITY 5 Sensitivity impairment affecting an area of skin greater than 50% of
8% the entire surface of a lower limb.


(8) CLINICAL PICTURES OF BALANCE DISORDERS
Balance is the sensory function that enables a person to keep his or her body in a stable position when in motion or at rest and to maintain a steady gaze with respect to head movements. It is controlled by the central nervous system, which combines and processes the visual, vestibular, and proprioceptive information required for appropriate motor responses.
For compensation purposes, all impacts related to balance disorders are presented under this single functional unit.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Impacts on other functional units, such as locomotion impairments due to a balance disorder, are included in the categories of severity of this unit.
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situation described in Severity 1.
THRESHOLD


Regular but brief bouts of unsteadiness, dizziness, or vertigo that
occur mainly during abrupt movements or changes of position but do
SEVERITY 1 not affect the ability to perform tasks of daily living.
2%
Regular therapeutic measures that may cause side effects are
justified.


Regular bouts of unsteadiness, dizziness, or vertigo that occur
despite therapeutic measures, such as difficulty walking (sensation
of drunkenness), feeling of insecurity on uneven ground, in a crowd,
SEVERITY 2 or in the dark.
5%
The person can perform tasks of daily living but cannot take part in
activities that could endanger his or her safety or that of others
such as activities involving heights or ladders.


SEVERITY 3 Regular bouts of unsteadiness, dizziness, or vertigo that occur
15% despite therapeutic measures and whose severity makes it impossible
to drive a car safely.


Regular bouts of unsteadiness, dizziness, or vertigo that occur
despite therapeutic measures and whose severity makes the
surveillance or assistance of another person necessary to perform
SEVERITY 4 many tasks of daily living.
30%
The person is still capable of independently performing simple tasks
of daily living such as doing household chores or taking care of
personal hygiene.


Regular bouts of unsteadiness, dizziness, or vertigo that occur
despite therapeutic measures and whose severity makes the
SEVERITY 5 surveillance or assistance of another person necessary to perform
60% most tasks of daily living.

The person is still capable of taking care of personal hygiene.


Regular bouts of unsteadiness, dizziness, or vertigo that occur
despite therapeutic measures and whose severity makes it impossible
SEVERITY 6 to stay upright.
100%
The person is confined to bed or a wheelchair, either at home or in
an institution.


(9) PHONATION
Phonation refers to the ability of mechanically producing vocal sounds that can be heard and understood and whose rate and flow can be maintained.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) The evaluation must take into account audibility, intelligibility, and flow quality.
— Audibility: Intensity of the voice
— Intelligibility: Quality of articulation and phonetic links
— Flow: Maintenance of rate and rhythm
(3) Language disorders related to a cognitive impairment must not be evaluated using the rules provided in this chapter but using the rules provided in the functional unit “Cognitive Aspect of Language”.
CATEGORIES OF SEVERITY


Inconveniences experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situations described in Severity 1.
THRESHOLD


Minor but perceptible impairment to audibility, intelligibility, or
SEVERITY 1 flow;
1%
or Change in speech timbre.


Audibility: Voice intensity is diminished but is sufficient to allow
normal conversation;

SEVERITY 2 or Intelligibility: Some difficulties and inaccuracies but articulation
5% is adequate for understanding;

or Fluidity: Verbal flow is slow, hesitant, or interrupted but is
adequate for normal conversation.


Audibility: Voice intensity quickly weakens. Close-up conversations
are possible but difficult in noisy settings;

SEVERITY 3 or Intelligibility: Family and friends understand, but strangers find
10% it difficult to understand and often ask the person to repeat;

or Fluidity: Verbal flow is slow and hesitant enough to limit
continuous speech to short periods.


Audibility: Voice intensity is very weak, like whispering. Telephone
conversations are impossible;

SEVERITY 4 or Intelligibility: Articulation is limited to pronouncing short,
20% familiar words;

or Fluidity: Verbal flow is very slow and arduous. Isolated words and
short sentences can be spoken but continuous speech cannot be
maintained.


SEVERITY 5 Absence or almost total absence of vocal function.
30%
Speech is inaudible or incomprehensible.


(10) MIMIC
Mimic refers to the ability to produce facial expressions using neuromusculoskeletal structures.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situations described in Severity 1.
THRESHOLD


Ability to produce facial expressions is slightly impaired such as
with a partial and minor impairment to a branch of the facial nerve,
SEVERITY 1 or an equivalent impairment resulting from the loss of mimic muscle
1% tissue;

or Occasional involuntary movements, such as facial synkinesia.


Ability to produce facial expressions is impaired over an area equal
to approximately one-quarter of the face such with a total
impairment to a frontal or mandibular branch of the facial nerve, or
SEVERITY 2 with an equivalent impairment resulting from the loss of mimic
3% muscle tissue;

or Frequent involuntary movements, such as facial synkinesia;

or Facial spasms.


Ability to produce facial expressions is impaired over an area equal
SEVERITY 3 to approximately one-half of the face such as with a total
7% unilateral impairment to a facial nerve or a partial bilateral
impairment of the facial nerves, or an equivalent impairment
resulting from the loss of mimic muscle tissue.


Ability to produce facial expressions is impaired over an area equal
SEVERITY 4 to approximately three-quarters of the face such with a complete
12% unilateral impairment to the facial nerve combined to a partial
contra lateral impairment, or an equivalent impairment resulting
from the loss of mimic muscle tissue.


SEVERITY 5 The ability to produce facial expressions is nonexistent or
15% virtually nonexistent.


(11) ABILITY TO MOVE AND MAINTAIN POSITION OF HEAD
The synergistic actions of anterior flexion, extension, lateral flexion and rotation of the neck make it possible to move and maintain the head in a stable position while performing numerous daily activities.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) The category of severity is determined by the situation with maximal impact, either the result of the overall weighted evaluation or any other situation described, including functional restrictions.
(3) The overall weighted evaluation is performed in the event of a decrease of active mobilization.
(a) The decrease in active mobilization is evaluated by measuring the maximum amplitudes of active movements obtained with optimal effort from the person being evaluated. The result must be consistent with the overall clinical evaluation. In the event of a discrepancy that cannot be explained with medically accepted knowledge, the passive movement measurement is used.
(b) The normal limit of the amplitude of the movement is obtained by comparison with the equivalent contralateral movement, as required. When this cannot be done or when the contralateral movement is faulty, use conventional values generally accepted as normal for the age of the person.
(c) For each movement, the importance of the loss is entered in the table. When, for a given movement, a result falls between 2 values, the closest value is used.
OVERALL WEIGHTED EVALUATION



Active Mobilization of the Cervical Region
_________________________________________________________________
|
| Anterior Flexion Flexion Rotation Rotation
| Flexion Extension to Left to Right to Left to Right
|_________________________________________________________________
Normal Limits |
(Normal ± a |
few degrees | 0 0 0 0 0 0
|_________________________________________________________________
Loss of |
approximately 25% | 2 2 1 1 4 4
|_________________________________________________________________
Loss of |
approximately 50% | 6 6 3 3 8 8
|_________________________________________________________________
Loss of |
approximately 75% | 10 10 5 5 20 20
|_________________________________________________________________
Loss of 90% |
or more | 15 15 10 10 25 25
__________________|_________________________________________________________________

Total Overall Weighted Evaluation = _________ Points
__________________________________________________________________
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as the loss of a few
MINIMUM degrees in the amplitude of movements without significant functional
THRESHOLD impact, are less than those resulting from the situation described
in Severity 1.


SEVERITY 1 The result of the overall evaluation of active mobilization capacity
2% is between 1 and 10, indicating a slight difficulty with activities
requiring moving and maintaining the position of the head.


The result of the overall evaluation of active mobilization capacity
is between 11 and 20, indicating a moderate difficulty with
activities requiring moving and maintaining the position of the
head;

or Regular and permanent inconveniences due to a medical necessity to
SEVERITY 2 avoid activities requiring
4%
- Extended periods of immobilization of the head and neck;

or

- Repetitive or frequent efforts that place significant strain on
the neck.


The result of the overall evaluation of active mobilization capacity
is between 21 and 40, indicating a significant difficulty with
SEVERITY 3 activities requiring moving and maintaining the position of the
8% head;

or Regular and permanent inconveniences due to a medical necessity

- To avoid activities requiring repetitive or frequent efforts
equivalent to handling loads of 5 to 10 kg.


SEVERITY 4 The result of the overall evaluation of active mobilization capacity
15% is between 41 and 60, indicating a severe difficulty with activities
requiring moving and maintaining the position of the head.


The result of the overall evaluation of active mobilization capacity
SEVERITY 5 is greater than 60.
30% Capacity to move or maintain the position of the head is nonexistent
or virtually nonexistent.


(12) ABILITY TO MOVE AND MAINTAIN POSITION OF TRUNK
The synergistic actions of anterior flexion, extension, lateral flexion, and rotation of the dorsal, lumbar, and sacral regions make it possible to move and maintain the trunk in a stable position while performing numerous daily activities.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Impacts on the ability to move and maintain the position of the trunk resulting from paraplegia or quadriplegia must not be evaluated using the rules provided in this unit but using the rules provided in the functional unit “Clinical Pictures of Paraplegia and Quadriplegia.”
(3) The category of severity is determined by the situation with maximal impact, either the result of the overall weighted evaluation or any other situation described, including functional restrictions.
(4) The overall weighted evaluation is performed in the event of a decrease of active mobilization.
(a) The decrease in active mobilization is evaluated by measuring the maximum amplitudes of active movements obtained with optimal effort from the person being evaluated. The result must be consistent with the overall clinical evaluation. In the event of a discrepancy that cannot be explained with medically accepted knowledge, the passive movement measurement is used.
(b) The normal limit of the amplitude of the movement is obtained by comparison with the equivalent contralateral movement, as required. When this cannot be done or when the contralateral movement is faulty, use conventional values generally accepted as normal for the age of the person.
(c) For each movement, the importance of the loss is entered in the table. When, for a given movement, a result falls between 2 values, the closest value is used.
OVERALL WEIGHTED EVALUATION



Active Mobilization of the Trunk
_________________________________________________________________
|
| Anterior Flexion Flexion Rotation Rotation
| Flexion Extension to Left to Right to Left to Right
|_________________________________________________________________
Normal Limits* |
(Normal ± a |
few degrees | 0 0 0 0 0 0
|_________________________________________________________________
Loss of |
approximately 25% | 5 2 2 2 2 2
|_________________________________________________________________
Loss of |
approximately 50% | 10 5 5 5 5 5
|_________________________________________________________________
Loss of |
approximately 75% | 15 8 8 8 8 8
|_________________________________________________________________
Loss of 90% |
or more | 25 12 12 12 12 12
__________________|_________________________________________________________________

Total Overall Weighted Evaluation = _________ Points
__________________________________________________________________
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as the loss of a few
MINIMUM degrees in the amplitude of movements without significant functional
THRESHOLD impact, are less than those resulting from the situation described
in Severity 1.


SEVERITY 1 The result of the overall evaluation of active mobilization capacity
2% is between 1 and 10, indicating a slight difficulty with activities
requiring moving and maintaining the position of the trunk.


The result of the overall evaluation of active mobilization capacity
is between 11 and 20, indicating a moderate difficulty with
activities requiring moving and maintaining the position of the
trunk;

or Regular and permanent inconveniences due to a medical necessity to
avoid activities requiring
SEVERITY 2
4% - Extended periods of immobilization of the trunk. Functional
restrictions are sufficient to limit periods of uninterrupted
driving to 1 or 2 hours;

or

- Repetitive or frequent efforts that place significant strain on
the trunk.


The result of the overall evaluation of active mobilization capacity
is between 21 and 40, indicating a significant difficulty with
activities requiring moving and maintaining the position of the
trunk;

or Regular and permanent inconveniences due to a medical necessity to
avoid activities requiring
SEVERITY 3
8% - Extended periods of immobilization of the trunk. Functional
restrictions are sufficient to limit periods of uninterrupted
driving to less than one hour;

or

- Repetitive or frequent efforts equivalent to handling loads of 5
to 10 kg.


The result of the overall evaluation of active mobilization capacity
is between 41 and 60, indicating a severe difficulty with activities
requiring moving and maintaining the 15% position of the trunk;

SEVERITY 4 or Regular and permanent inconveniences due to a medical necessity to
15% avoid activities requiring

- Extended periods of immobilization of the trunk. Functional
restrictions are sufficient to prevent or limit periods of
uninterrupted driving to a few minutes.


The result of the overall evaluation of active mobilization capacity
SEVERITY 5 is greater than 60.
30%
Capacity to move or maintain the position of the trunk is
nonexistent or virtually nonexistent.


(13) ABILITY TO MOVE AND MAINTAIN POSITION OF UPPER LIMB
The function of moving and maintaining the position of an upper limb, especially an hand*, makes it possible to reach and move objects in the pericorporeal space. It also makes it possible to reach various parts of the body, notably for personal care and hygiene.
* In the event of amputations, the distal extremity of the limb
This function is composed of two functional units.
(13.1) Ability to Move and Maintain Position of Right Upper Limb
(13.2) Ability to Move and Maintain Position of Left Upper Limb
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Impacts on the ability to move and maintain the position of an upper limb resulting from quadriplegia must not be evaluated using the rules provided in this unit but using the rules provided in the functional unit “Clinical Pictures of Paraplegia and Quadriplegia.”
(3) In the case of an amputation, “Manuel Dexterity” must also be evaluated.
(4) The dominant limb shall be the limb most frequently used for daily activities, notably for writing.
(5) The category of severity is determined by the situation with maximal impact, either the result of the overall weighted evaluation or any other situation described, including functional restrictions.
(6) The overall weighted evaluation is performed in the event of a decrease of active mobilization.
(a) The decrease in active mobilization is evaluated by measuring the maximum amplitudes of active movements obtained with optimal effort from the person being evaluated. The result must be consistent with the overall clinical evaluation. In the event of a discrepancy that cannot be explained with medically accepted knowledge, the passive movement measurement is used.
(b) The normal limit of the amplitude of the movement is obtained by comparison with the equivalent contralateral movement. When this cannot be done or when the contralateral movement is faulty, use conventional values generally accepted as normal for the age of the person.
(c) For each movement, the importance of the loss is entered in the table.
— When the measure of the loss of amplitude of movement falls between 2 values, the closest value is used.
— When an examination indicates a decrease in both amplitude of the movement and muscle strength, the highest score is used.
OVERALL WEIGHTED EVALUATION

Active Mobilization
Shoulder Elbow
Loss of Amplitude of Movements Muscle strength within normal limits (5/5) Anterior Elevation Extension Abduction Adduction Internal Rotation External Rotation Flexion Extention
Normal limits
(Normal ± a few degrees) 0 0 0 0 0 0 0 0
Loss of approximately 10% 1 0.5 1 0.5 1 0.5 1 1
Loss of approximately 25% 4 1 4 1 2 0.5 9 5
Loss of approximately 50% 10 2 10 2 4 2 20 10
Loss of approximately 75% 15 3 15 3 5 3 30 26
Loss of 90% or more 21 5 21 5 8 5 35 35
Total ankylosis in normal position of function 44 30
Total ankylosis in faulty position 65 35
Muscle Weakness Complete active movement against moderate resistance (4/5) 4 1 4 1 2 0.5 9 5
Complete active movement against gravity (3/5) 10 2 10 2 4 2 20 10
Complete active movement with gravity eliminated (2/5) 15 3 15 3 5 3 30 26
Nonexistent active movement or limited to palpable contractions 21 5 21 5 8 5 35 35
Total of Overall Weighted Evaluation = _________ Points

(13.1) ABILITY TO MOVE AND MAINTAIN POSITION OF RIGHT UPPER LIMB
(13.2) ABILITY TO MOVE AND MAINTAIN POSITION OF LEFT UPPER LIMB
Non-dominant Limb: (ND) Dominant Limb: (D)
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as the loss of a few
MINIMUM degrees in the amplitude of movements without significant functional
THRESHOLD impact, are less than those resulting from the situation described
in Severity 1.


SEVERITY 1 The result of the overall evaluation of active mobilization capacity
ND 1% is between 0.5 and 3, indicating a very slight difficulty with
D 1% activities requiring moving and maintaining the position of the
upper limb.


The result of the overall evaluation of active mobilization capacity
is between 3.5 and 6, indicating a slight difficulty with activities
requiring moving and maintaining the position of the upper limb;

SEVERITY 2 or Regular and permanent inconveniences due to a medical necessity to
ND 2% avoid activities requiring repetitive or frequent efforts
D 2.5%
- That place significant strain on the upper limb;

or

- Requiring the moving of heavy objects.


The result of the overall evaluation of active mobilization capacity
is between 6.5 and 16, indicating a moderate difficulty with
SEVERITY 3 activities requiring moving and maintaining the position of the
ND 4% upper limb;
D 5%
or Regular and permanent inconveniences due to a medical necessity to
avoid activities requiring repetitive or frequent efforts

- Equivalent to moving loads of approximately 5 to 10 kg.


SEVERITY 4 The result of the overall evaluation of active mobilization capacity
ND 8% is between 16.5 and 36, indicating a significant difficulty with
D 10% activities requiring moving and maintaining the position of the
upper limb.


SEVERITY 5 The result of the overall evaluation of active mobilization capacity
ND 15% is between 36.5 and 59, indicating a very significant difficulty
D 18% with activities requiring moving and maintaining the position of the
upper limb.


SEVERITY 6 The result of the overall evaluation of active mobilization capacity
ND 20% is between 60 and 89, indicating a severe difficulty with activities
D 24% requiring moving and maintaining the position of the upper limb.


Active mobilization capacity of the upper limb is nonexistent or
SEVERITY 7 virtually nonexistent.
ND 24%
D 30% The result of the overall evaluation of active mobilization capacity
is 90 or more.


(14) MANUAL DEXTERITY (prehension and manipulation)
The manual dexterity function refers to the prehension, manipulation, and release of objects. Fine dexterity allows for the quick or precise manipulation of small objects with the fingers while gross dexterity allows for the manipulation of larger objects with the whole hand.
Manual dexterity is composed of 2 functional units:
(14.1) Right Manual Dexterity
(14.2) Left Manual Dexterity
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Impacts on manual dexterity resulting from quadriplegia must not be evaluated using to the rules provided in this unit but using the rules provided in the functional unit “Clinical Pictures of Paraplegia and Quadriplegia.”
(3) Impacts resulting from an impairment to skin sensitivity of a hand must also be evaluated using the rules provided in the functional unit “Skin Sensitivity of Upper Limb.”
(4) The dominant limb shall be the limb most frequently used for daily activities, notably for writing.
(5) The category of severity is determined by the situation with maximal impact, either the result of the overall weighted evaluation or any other situation described, including functional restrictions.
(6) The overall weighted evaluation is performed in the event of a decrease of active mobilization.
(1) The decrease in active mobilization is evaluated by measuring the maximum amplitudes of active movements obtained with optimal effort from the person being evaluated. The result must be consistent with the overall clinical evaluation. In the event of a discrepancy that cannot be explained with medically accepted knowledge, the passive movement measurement is used.
(2) The normal limit of the amplitude of the movement is obtained by comparison with the equivalent contra lateral movement. When this cannot be done or when the contra lateral movement is faulty, use conventional values generally accepted as normal for the age of the person.
(3) For each movement, the importance of the loss is entered in the tables provided.
(4) The result of the overall weighted evaluation is the sum of the scores obtained in Tables A, B and C.
Table A: Fine and Power Grasp
Table B: Manipulation: Contribution of the Fingers
Table C: Manipulation: Contribution of the Wrist and Elbow/Forearm
— In Table C, when the result falls between 2 values, the closest value is used.
— In Tables B and C, when the examination indicates a decrease in both amplitude of the movement and muscle strength, the highest score is used.
TABLE A
FINE AND POWER GRASP
The quality of the grasp is evaluated on the basis of precision, strength, and speed of execution in grasping, holding, and releasing objects.
uu Slight difficulty The quality of the grasp is slightly diminished but grasping remains possible and efficient without compensation by other parts of the hand.
uu Difficult, but The quality of the grasp is diminished but grasping remains possible and efficient with
remains efficient synergistic compensation by other parts of the hand.
uu Difficult, Despite synergistic compensation by other parts of the hand, the quality of the grasp is
not very efficient significantly diminished. However, the grasp retains a certain usefulness.
uu Inefficient Despite synergistic compensation by other parts of the hand, grasping in inefficient or
or impossible impossible with this hand.

Difficult
Within Normal Limits Slight Difficulty Remains Efficient Not Very Efficient Inefficient or Impossible
Fine Grasp Bipulpar / Ungual
(sheet of paper / paper clip) 0 1 3 12 20
Tridigital (pen) 0 1 3 12 20
Pollici-latérodigitale (key) 0 1 3 12 20


Power Grasp Hook (pail, briefcase) 0 1 3 12 20
Cylindrical / Spherical
(hammer / ball, bottle) 0 1 3 12 20
Directional (screwdriver) 0 1 3 12 20
Total of Table A =________ Points
TABLE B
MANIPULATION: CONTRIBUTION OF FINGERS

Active Mobilization
Thumb* Index Finger* Middle Finger* Ring Finger* Little Finger*
Loss of Amplitude of Movements Muscle Strength (4 or 5/5) IP MP CM DIP PIP MP DIP PIP MP DIP PIP MP DIP PIP MP
Normal limits 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Decrease in amplitude of movement, functional position maintained 6 6 6 1.5 1.5 0.75 2 2 1 1 1 0.5 1.5 1.5 0.75
Total ankylosis in functional position 12 10 10 4 4 2 6 6 3 3 3 1.5 4 4 2
Total ankylosis in incomplete or faulty position 20 12 12 8 4 3 10 6 4 5 3 2 8 4 3

Amputation 20 12 12 8 4 3 10 6 4 5 3 2 8 4 3
When the amputation of a phalanx is partial, the score used is the one indicated for the joint closest to the site of the amputation.
In the case of the distal phalanx, no score is given if more than 50% of the normal length of the phalanx is preserved.

Muscle Weakness
(3/5 or less) 20 12 12 8 4 3 10 6 4 5 3 2 8 4 3
Total of Table B = _______ Points

* IP: Interphalagial
PIP: Proximal Interphalangial
DIP: Distal Interphalangial
MP: Metacarpo-phalangial
CM: Carpo-metacarpal
TABLE C
MANIPULATION: CONTRIBUTION OF WRIST AND ELBOW/FOREARM

Active Mobilization
Wrist Elbow / Forearm
Loss of Amplitude of Movements Muscle strength within normal limits (5/5) Flexion Extension Radial Deviation Ulnar Deviation Pronation Supination
Normal limits
(Normal ± a few degrees) 0 0 0 0 0 0
Loss of approximately 10% 2 2 0.5 0.5 2 2
Loss of approximately 25% 5 5 1 2 3 3
Loss of approximately 50% 10 10 3 4 8 8
Loss of approximately 75% 15 18 5 5 15 15
Loss of 90% or more 18 20 6 6 18 18
Total ankylosis in functional position 50 36
Total ankylosis in faulty position 60 40

Muscle Weakness Complete active movement against moderate resistance (4/5) 5 5 1 2 3 3
Complete active movement against gravity (3/5) 10 10 3 4 8 8
Complete active movement with gravity removed (2/5) 15 18 5 5 15 15
Nonexistent active movement or movement limited to palpable contractions 18 20 6 6 18 18
Total of Table C = ________ Points
(14.1) RIGHT MANUAL DEXTERITY
(14.2) LEFT MANUAL DEXTERITY
Non-dominant Limb: (ND) Dominant Limb: (D)
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as the loss of a few
MINIMUM degrees in the amplitude of movements without significant functional
THRESHOLD impact, are less than those resulting from the situation described
in Severity 1.


The result of the overall evaluation of active mobilization capacity
is between 0.5 and 6.5, indicating a very slight difficulty for
SEVERITY 1 activities requiring manual dexterity;
ND 1%
D 1% or Regular and permanent inconveniences due to the medical necessity to
avoid exposure to cold such as with a vascular impairment like a
Raynaud’s phenomenon.


SEVERITY 2 The result of the overall evaluation of active mobilization capacity
ND 2% is between 7 and 14.5, indicating a slight difficulty for activities
D 2.5% requiring manual dexterity.


The result of the overall evaluation of active mobilization capacity
SEVERITY 3 is between 15 and 29.5, indicating a moderate difficulty for
ND 4% activities requiring manual dexterity;
D 6%
or Clumsiness such as trembling or dysmetria that nevertheless allows
the person to use the hand for personal care.


SEVERITY 4 The result of the overall evaluation of active mobilization capacity
ND 6% is between 30 and 49.5, indicating a significant difficulty for
D 8% activities requiring manual dexterity.


SEVERITY 5 The result of the overall evaluation of active mobilization capacity
ND 12% is between 50 and 79.5, indicating a very significant difficulty for
D 15% activities requiring manual dexterity.


SEVERITY 6 The result of the overall evaluation of active mobilization capacity
ND 18% is between 80 and 129.5, indicating a severe difficulty for
D 22% activities requiring manual dexterity.


SEVERITY 7 The result of the overall evaluation of active mobilization capacity
ND 28% is between 130 and 199.5, indicating a very severe difficulty for
N 35% activities requiring manual dexterity. Manual dexterity is limited
to a minimum of useful activities.


SEVERITY 8 The result of the overall evaluation of active mobilization capacity
ND 40% is 200 or more. Manual dexterity is nonexistent or virtually
D 50% nonexistent. No useful or effective action possible.


(15) LOCOMOTION
Locomotion is the capacity to move from place to place. It also allows people to adopt and change body positions. Locomotion is the result of the functional synergy between the two lower limbs, the pelvis, and the trunk.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Impacts on locomotion resulting from paraplegia, quadriplegia, or balance disorders must not be evaluated using the rules provided in this unit but using the rules provided in the functional units “Clinical Pictures of Paraplegia and Quadriplegia” or ’Clinical Pictures of Balance Disorders.”
(3) The term “efficiency” used in the categories of severity refers to the time it takes to perform the activity and the quality of the result.
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as less than 1 cm
MINIMUM difference in leg length or the loss of a few degrees of active
THRESHOLD mobilization with no significant functional impact, are less than
those resulting from the situations described in Severity 1.


Locomotion capacity is slightly reduced.

Limitations: Walking at an ordinary pace, walking at a brisk pace,
running, and performing complex movements are affected
but remain efficient(1), notably by changing certain
normal movements.

For example, slight functional impact resulting from
joint instability, patello-femoral syndrome, or a decrease
in the amplitude of one or more hip, knee, or ankle
movements.

SEVERITY 1 (1) Efficient: The time it takes to perform the
2% activity and the quality of the result remain within
normal limits.

Restrictions: The extent compares to such restrictions as those
imposed by the need to wear
- A lift or corrective shoe insert to compensate for
differences in leg lengths of 1 cm to 3.5 cm;

- A custom-fitted shoe to compensate for a
disfigurement of the foot;

- Support stockings to satisfactorily control of
circulatory disorders.


Locomotion capacity is moderately reduced.

Limitations: Walking occurs with a limp, despite the use of a
technical aid like a corrective shoe insert,

or Walking at a brisk pace or running is less efficient
but remains possible;

or Negotiating changes in ground level, stairs, and
uneven ground is less efficient(1), but remains
possible,

or Uninterrupted walking is limited to approximately
300 m to 500 m due to intermittent claudication;

or Complex movements like kneeling and crouching are less
efficient but remain possible, notably by performing
them more slowly and making changes to normal
movements.

(1) Less efficient: Activity remains possible but
SEVERITY 2 takes more time to be performed OR the quality of the
6% result is diminished.

Restrictions: The extent compares to such restrictions as those
imposed by the need

- To wear a lift or corrective shoe insert to
compensate for differences in leg lengths exceeding
3.5 cm;

- To wear a prosthesis or custom-fitted shoe because
of the amputation of the 1st toe;

- To wear hinged knee brace, which is medically
justified by symptomatic instability of the knee and
necessary for performing demanding activities such
as certain sports;

- To undergo medical or surgical treatments due to
frequent, episodic exacerbations such as
osteomyelitis relapses;

- To reduce locomotion activities due to circulatory
problems that are poorly controlled despite
therapeutic measures like with some cases of
post-phlebitis syndrome.


Locomotion capacity is significantly reduced.

Limitations: Walking at brisk pace or running is only possible over
very short distances such as with an arthrodesis of
one ankle;

or Negotiating changes in ground level, stairs, and
uneven ground is only possible over very short
distances;

or Uninterrupted walking is limited to approximately
120 m to 300 m due to intermittent claudication;

SEVERITY 3 or Complex movements like kneeling and crouching are
12% inefficient or impossible.

Restrictions: The extent compares to such restrictions as those
imposed by the need to wear

- A tibial-pedal prosthesis in the case of a
neurological impairment with drop foot for example;

- A hinged knee brace, which is medically justified by
symptomatic instability of the knee and permanently
necessary for performing all activities;

- A prosthesis or custom-fitted shoe because of an
amputation at the median point of a foot.


Locomotion capacity is very significantly reduced.

Limitations: Walking at brisk pace or running is inefficient or
impossible even over very short distances;

SEVERITY 4 or Uninterrupted walking is limited to approximately 75 m
20% to 120 m due to intermittent claudication.

Restrictions: The extent compares to such restrictions as those
imposed by the need to wear

- A prosthesis because of an amputation at the ankle.


Locomotion capacity is severely reduced.

Limitations: Uninterrupted walking is limited to under 75 m due to
intermittent claudication,

Restrictions: The extent compares to such restrictions as those
imposed by the need to wear
SEVERITY 5
30% - A femoral-pedal orthesis due to a severe impairment
to the entire limb;

- A prosthesis with patellar support due to an
amputation below the knee;

- A prosthesis due to an amputation at the median
point of both feet or both ankles.


Locomotion capacity is reduced to a minimum of useful activities.

Limitations: Moving about requires the use of 2 canes or 2 crutches.
Moving about out of doors may require the use of a
walker or wheelchair.

Restrictions: The extent compares to such restrictions as those
SEVERITY 6 imposed by the need to wear
45%
- A prosthesis due to a disarticulation of a knee, an
amputation of a limb at the thigh level, or an
amputation below the knee not permitting the wearing
of a prosthesis with patellar support;

- Prosthesis with patellar support due to amputation
below the knee of both limbs.


Locomotion capacity is nonexistent or almost nonexistent.

Limitations: Moving about requires the use of a wheelchair.
SEVERITY 7
60% Restrictions: The extent compares to such restrictions as those
imposed by the need to wear

- Prosthesis due to amputation at the thigh of both
limbs.


(16) PROTECTION PROVIDED BY THE SKULL
The protection provided by the skull helps maintain the integrity of the brain.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) The evaluation must take into consideration the extent of any inconvenience resulting from preventive restrictions made necessary by a permanent, unrepairable loss of continuity of the skull.
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as burr holes, are
MINIMUM less than those resulting from the situation described in Severity
THRESHOLD 1.


SEVERITY 1 Preventive restrictions made necessary by a permanent loss of
2% continuity of the skull such as an unrepaired section affecting an
area equal to or greater than 3 cm2.


(17) PROTECTION PROVIDED BY THE RIB CAGE AND ABDOMINAL WALL
The protection provided by the rib cage and abdominal wall helps maintain the integrity of the contents of the thorax and abdomen.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) When the presence of hernia is noted, it may be incisional, inguinal, femoral, umbilical or epigastric.
(3) Impacts on digestive or respiratory functions must not be evaluated using the rules provided in this chapter but using the rules provided in the functional units that specifically deal with the observed impacts.
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental suffering, pain,
and other consequences - resulting from a permanent impairment can be compared with those that
would result from the situation with maximum impact among the following:



UNDER THE After-effects of the permanent impairment, such as a faulty
MINIMUM consolidation of a rib or ribs with no functional impact or a
THRESHOLD repaired nonrecurrent hernia, are less than those resulting from the
situations described in Severity 1.


Inconveniences resulting from the medical necessity of functional
restrictions or treatments required by

- Defects in the abdominal wall such as a recurrent or surgically
SEVERITY 1 unrepairable readily reducible single hernia;
1%
or

- A limited but surgically unrepairable defect in the rib cage such
as exeresis, pseudoarthrosis, or abnormal consolidation of one
rib.


Inconveniences resulting from the medical necessity of functional
restrictions or treatments required by

- Defects in the abdominal wall such as recurrent or surgically
SEVERITY 2 unrepairable readily reducible hernias;
2%
or

- A significant, surgically unrepairable defect in the rib cage such
as exeresis, pseudoarthrosis, or abnormal consolidation of several
ribs.


Inconveniences resulting from the medical necessity of functional
SEVERITY 3 restrictions or treatments required by
5%
- Defects in the abdominal wall such as recurrent or surgically
unrepairable hard to reduce hernia(s).


Inconveniences resulting from the medical necessity of functional
SEVERITY 4 restrictions or treatments required by
7%
- Defects in the abdominal wall such as recurrent or surgically
unrepairable non reducible hernias.


(18) NASOPHARYNGEAL RESPIRATION
Nasopharyngeal respiration, which is provided by the nose, sinuses, and pharynx, allows the passage, filtration, moistening, and heating of air.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situations described in Severity 1.
THRESHOLD


Partial unilateral decrease in nasal air flow;
SEVERITY 1
1% or Local, unilateral irritant phenomena that may result, for example,
from a perforation of the nasal septum or damage to the mucosa.


Total unilateral or partial bilateral decrease in nasal air flow;

SEVERITY 2 or Local, bilateral irritant phenomena that may result, for example,
2% from a perforation of the nasal septum or damage to the mucosa;

or Need for medical treatments or follow-ups due to chronic, persistent
sinus infections.


SEVERITY 3 Total bilateral nasal obstruction permanently requiring breathing
5% through the mouth.


(19) DIGESTIVE FUNCTIONS
Digestive functions enable people to use food to produce energy, to grow, and to keep their bodies functioning.
Digestive functions are composed of 4 functional units.
(19.1) Ingestion (chewing and swallowing including prehension and salivation)
(19.2) Digestion and Absorption
(19.3) Excretion
(19.4) Hepatic and Biliary Functions
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Impacts on digestive functions resulting from paraplegia or quadriplegia must not be evaluated using the rules provided in this chapter but using the rules provided in the functional unit “Clinical Pictures of Paraplegia and Quadriplegia.”
(3) The table below specifies the relative degree of the terms used in the descriptions of the categories of severity describing the impairments of the hepatic and biliary functions as “slight”, “moderate”, or “severe”. Depending on the circumstances, the evaluation of the functional impairment may be documented by any other appropriate specific examination.
_______________________________________________________________
|
Specific Evaluation |“Slight” Impairment “Moderate” Impairment “Severe” Impairment
Criteria |
____________________|_______________________________________________________________
|
Bilirubin | 0 - 35 > 35 - 100 > 100
____________________|_______________________________________________________________
|
Albumin | > 35 25 - 35 < 25
____________________|_______________________________________________________________
|
Ascites | - Medically controlled Uncontrolled
____________________|_______________________________________________________________
|
Neurological | - Controlled or Poorly controlled,
Signs | intermittent severe
____________________|_______________________________________________________________
|
Nutritional | Excellent Good Poor
Status |
____________________|_______________________________________________________________
|
INR* | Normal > 1.5 - 2.5 > 2.5
____________________|_______________________________________________________________
* International Normalized Ratio
(19.1) INGESTION: Chewing and Swallowing Including Prehension and Salivation
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as dental impairment
MINIMUM or slight malocclusion with no impact on chewing, are less than
THRESHOLD those resulting from the situations described in Severity 1.


Loss of one or more teeth with the possibility of correction using a
fixed prosthesis or implants;

or Unrepairable dental impairment sufficient to affect chewing;

SEVERITY 1 or Area(s) of altered sensitivity sufficient to affect chewing;
1%
or Hyposalivation or hypersalivation sufficient to affect chewing or
swallowing;

or Limitations to mouth opening, which nonetheless remains equal to or
greater than 35 mm.


Loss of teeth with the possibility of correction using a removable
prosthesis (including any related inconveniences), but not
technically correctable with a fixed prosthesis or implants;

or Slight temporo-mandibular dysfunction sufficient to affect chewing;
SEVERITY 2
2% or Malocclusion sufficient to affect chewing;

or Limitations to mouth opening, which nonetheless remains equal to or
greater than 30 mm;

or Mild salivary incontinence.


Total edentation of one maxilla with the possibility of correction
using a removable prosthesis (including any related inconveniences),
but not technically correctable with implants;

or Moderate to severe temporo-mandibular dysfunction;
SEVERITY 3
5% or Limitations to mouth opening, which nonetheless remains equal to or
greater than 20 mm;

or Moderate to severe salivary incontinence;

or Medical necessity on a regular and permanent basis to follow a
restrictive diet combined with medical treatments.


Total edentation of both maxillae with the possibility of correction
using removable prostheses (including any related inconveniences),
but not technically correctable with implants;

SEVERITY 4 or Limitations to mouth opening, which nonetheless remains equal to or
10% greater than 10 mm;

or Salivary and alimentary incontinence;

or Sufficient discomfort when chewing or swallowing to justify a soft
diet (purees) on a permanent basis.


Total edentation of both maxillae, technically not correctable;

or Limitations to mouth opening, which is less than 10 mm;

or Sufficient discomfort on chewing or swallowing to justify a liquid
SEVERITY 5 diet on a permanent basis;
25%
or Necessity for artificial feeding on an intermittent basis combined
with ongoing medical treatments or occasional surgical treatments;

or Medical necessity to perform serial dilations on a regular basis,
which may cause severe functional discomfort.


SEVERITY 6 The function is nonexistent or virtually nonexistent, making
40% artificial feeding necessary on a permanent basis.


(19.2) DIGESTION AND ABSORPTION
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situation described in Severity 1.
THRESHOLD


SEVERITY 1 Medical necessity on a regular and permanent basis to take
2% medication to facilitate digestion or absorption, including possible
side effects.


SEVERITY 2 Medical necessity on a regular and permanent basis to follow a
5% restrictive diet combined with medical treatments.


Sufficient functional discomfort to affect nutritional status. The
impairment is confirmed by clinical and laboratory testing and is
associated with permanent weight loss of approximately 10% in
SEVERITY 3 comparison with prior weight or, according to circumstances, with
10% the recommended weight for the age, sex, and body type;

or Medical necessity to undergo treatments due to episodic
exacerbations such as one or 2 episodes a year of recurrent chronic
pancreatitis.


Sufficient functional discomfort to affect nutritional status. The
impairment is confirmed by clinical and laboratory testing and is
associated with permanent weight loss of 15 20% to in comparison
with prior weight or, according to circumstances, with the
recommended weight for the age, sex, and body type;
SEVERITY 4
25% or Medical necessity to undergo treatments due to frequent
exacerbations such as 3 episodes or more a year of recurrent chronic
pancreatitis;

or Medical necessity for intermittent artificial feeding combined with
ongoing medical treatments and/or occasional surgical treatments.


Sufficient functional discomfort to affect nutritional status. The
impairment is confirmed by clinical and laboratory testing and is
associated with permanent weight loss of 25% or more in comparison
SEVERITY 5 with prior weight or, according to circumstances, with the
40% recommended weight for the age, sex, and body type;

or Medical necessity on a permanent basis for artificial feeding
combined with ongoing medical treatments and/or occasional surgical
treatments.


SEVERITY 6 The function is nonexistent or virtually nonexistent, making
50% intravenous feeding necessary on a permanent basis.


(19.3) EXCRETION
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as the presence of
MINIMUM non urgent diarrhea, are less than those resulting from the
THRESHOLD situation described in Severity 1.


Urgent diarrhea on a regular and permanent basis with an average
SEVERITY 1 frequency of approximately 1 to 2 times a day;
2%
or Medical necessity on a regular and permanent basis to take
medication to facilitate excretion, including possible side effects.


Urgent diarrhea on a regular and permanent basis with an average
SEVERITY 2 frequency of approximately 3 to 5 times a day;
5%
or Manifestations of fecal incontinence (soiling) that justify the
constant wearing of protection.


Urgent diarrhea on a regular and permanent basis with an average
SEVERITY 3 frequency over 5 times a day;
10%
or Fecal incontinence of formed stools with an average frequency of 5
times or less a week.


SEVERITY 4 Total fecal incontinence;
35%
or Need for a permanent colostomy.


SEVERITY 5 Need for a permanent ileostomy.
40%


(19.4) HEPATIC AND BILIARY FUNCTIONS
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as the presence of
MINIMUM biochemical anomalies that have no clinical impact and require no
THRESHOLD special medical follow-up, are less than those resulting from the
situation described in Severity 1.


SEVERITY 1 Medical necessity on a regular and permanent basis to take
2% medication to facilitate hepatic and biliary functions, including
possible side effects.


SEVERITY 2 “Slight” functional impairment according to specific evaluation
5% criteria.


Sufficient functional discomfort to affect nutritional status. The
impairment is confirmed by clinical and laboratory evaluations and
is associated with permanent weight loss of approximately 10% in
comparison with prior weight or, according to circumstances, with
SEVERITY 3 the recommended weight for the age, sex, and body type;
10%
or Medical necessity to undergo treatments due to episodic
exacerbations like recurrent cholangitis;

or Medical necessity on a permanent basis for serial dilations due to
an impairment to the biliary tree.


“Moderate” functional impairment according to specific evaluation
criteria;

or Sufficient functional discomfort to affect nutritional status. The
SEVERITY 4 impairment is confirmed 4 by clinical and laboratory testing and is
25% associated with permanent weight loss of 15 to 20% in comparison
with prior weight or, according to circumstances, with the
recommended weight for the age, sex, and body type;

or Medical necessity to install an endoprosthesis with regular changes
due to an impairment of the biliary tree.


“Severe” functional impairment according to specific evaluation
criteria;

or Sufficient functional discomfort to affect nutritional status. The
SEVERITY 5 impairment is confirmed by clinical and laboratory testing and is
40% associated with permanent weight loss of 25% or more in comparison
with prior weight or, according to circumstances, with the
recommended weight for the age, sex, and body type;

or Medical necessity for long-term percutaneous drainage.


(20) CARDIO-RESPIRATORY FUNCTION
The cardiac and respiratory functions act together to oxygenate the blood and eliminate carbon dioxide so that people can produce energy and keep their bodies functioning.
The cardiac and respiratory functions are grouped under one functional unit.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Impacts on cardio-respiratory function resulting from quadriplegia must not be evaluated using the rules provided in this chapter but using the rules provided in the functional unit “Clinical Pictures of Paraplegia and Quadriplegia.”
(3) Impacts on other functional units resulting from an impairment of the cardio-respiratory function must not be evaluated using the rules provided in this chapter but using the rules provided in the functional units that specifically deal with the observed impacts.
(4) Endurance is the specific preferred criterion for overall evaluation of the cardio-respiratory function. Evaluations must be performed under optimal conditions, i.e., with maximum therapy. Depending on the circumstances, the impairment must be confirmed using one or more of the following tests:
(A) Evaluation of the cardiac function
· Electrocardiogram with Holter if necessary
· Stress test
· Echocardiogram
· Any other specific examination appropriate to the circumstances
(B) Evaluation of the respiratory function
The table below specifies the relative degree of the terms used in the descriptions of the categories of severity describing the impairments of the respiratory function as “moderate” “significant” or “severe.” Depending on the circumstances, the evaluation of the functional impairment may be documented by any other appropriate specific examination.
The VO2MAX measurement is the predominant criterion for evaluating the extent of functional loss. When the actual loss is clinically greater, the evaluation may be documented using the other parameters indicated in the table as well as any other specific examination such as radiological examinations or measurements of other pulmonary volumes by plethysmography.


Parameter Normal Moderate Signifiant Severe
Limits Impairment Impairment Impairment



VO2MAX > 25 ml / 20 to 25 ml / 15 to 19 ml / < 15 ml /
(kg x min) (kg x min) (kg x min) (kg x min)


FVC / predicted ≥ 80% 60% to 79% 51% to 59% ≤ 50%


DLC / predicted ≥ 70% 60% to 69% 41% to 59% ≤ 40%


CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situations described in Severity 1.
THRESHOLD


Slight functional discomfort. However, endurance remains normal or
almost normal.

Respiratory: Difficulty breathing due to partial pulmonary exeresis,
or a parietal, diaphragm, or pleural impairment.

SEVERITY 1 Note: For a more significant functional impact, the
2% category of severity is determined by respiratory
function tests.

Cardiac: Functional impairment documented by a positive maximum
stress test at over 7 mets;

or Documented arrhythmia satisfactorily controlled by
medication.


Respiratory: Abnormal and permanent dyspnea with significant
physical effort;

SEVERITY 2 or Difficulty breathing clinically manifested by a
5% permanent stridor.

Cardiac: Functional impairment documented by a positive maximum
stress test at 7 mets.


Limited endurance capacity. Unaccustomed physical activity or
significant physical effort causes excessive fatigue, palpitations,
dyspnea, or angina. The person remains comfortable at rest and while
performing normal daily physical activities.

Respiratory: Abnormal and permanent dyspnea when walking uphill at a
normal pace;

SEVERITY 3 or “Moderate” impairment of the respiratory function
10% documented by respiratory function tests.

Cardiac: Functional impairment documented by a positive maximum
stress test at 6 mets;

or Documented arrhythmia satisfactorily controlled by a
pacemaker;

or Functional impairment documented by an ejection
fraction of 40% to 50%.


Respiratory: Inconveniences related to the presence of a permanent
tracheotomy.

SEVERITY 4 Cardiac: Functional impairment documented by a positive maximum
20% stress test at 5 met;

or Functional impairment documented by an ejection
fraction of 30% to 39%.


Limited endurance capacity. Performing normal daily physical
activities causes excessive fatigue, palpitations, dyspnea, or
angina. The person remains comfortable at rest.

Respiratory: Abnormal and permanent dyspnea requiring stopping
(after approximately 100 m) when walking at a normal
pace on flat ground;
SEVERITY 5
30% or “Significant” impairment of the respiratory function
documented by respiratory function tests.

Cardiac: Functional impairment documented by a positive maximum
stress test at 4 mets;

or Functional impairment documented by an ejection
fraction of 25% to 29%.


Respiratory: Abnormal and permanent dyspnea that occurs while
performing daily activities that require little effort
such as walking at a slow pace on flat ground;

SEVERITY 6 or “Severe” impairment of the respiratory function
60% documented by respiratory function tests.

Cardiac: Functional impairment documented by a positive maximum
stress test at 2 or 3 mets;

or Functional impairment documented by an ejection
fraction of 20% to 24%.


Very limited endurance capacity. All physical activity causes an
increase in clinical signs. The person is uncomfortable performing
the least physical activity and is uncomfortable even at rest.

SEVERITY 7 Respiratory: Abnormal and permanent dyspnea with the least effort;
85%
or Need for permanent oxygen therapy (15-18 hours/day).

Cardiac: Functional impairment documented by a positive maximum
stress test at less than 2 mets;

or Functional impairment documented by an ejection
fraction of less than 20%.


SEVERITY 8 Absence of spontaneous respiration and dependence on a respirator.
100%


(21) URINARY FUNCTIONS
The functions of the urinary tract is to eliminate metabolic waste from the body and control the concentrations of the various components of the blood and other body fluids.
Urinary functions are composed of 2 functional units.
(21.1) Renal Function
(21.2) Micturition
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Impacts on urinary functions resulting from paraplegia or quadriplegia must not be evaluated using the rules provided in this chapter but using the rules provided in the functional unit “Clinical Pictures of Paraplegia and Quadriplegia.”
(3) Impacts on other functional units resulting from complications due to high blood pressure must not be evaluated using the rules provided in this chapter but using the rules provided in the functional units that specifically deal with the observed impacts.
(4) The measurement of creatinine clearance is the main criterion for documenting an impairment to the renal function. Depending on the circumstances, the evaluation of the functional impairment may be documented by any other appropriate specific examination such as renal scanning.
(21.1) RENAL FUNCTION
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as biochemical or
MINIMUM hematological anomalies with no significant clinical impacts, are
THRESHOLD less than those resulting from the situation described in
Severity 1.


Inconveniences related to the need on a regular and permanent basis
SEVERITY 1 to take medication due to high blood pressure, including possible
2% side effects. Blood pressure is maintained at 160/90 or less with
the treatment.


Persistent high blood pressure, minima between 90 and 120, despite
taking medication on a regular and permanent basis;

or Renal function diminished but remaining greater than 75% of normal;
SEVERITY 2
5% or Occasional exacerbations caused by high urinary tract infections
(2 to 3 per year) despite treatments and medical follow-up;

or Preventive restrictions due to the relative risk represented by the
shutdown or the loss of a kidney.


Persistent high blood pressure, minima greater than 120, despite
taking medication on a regular and permanent basis;

or Renal function diminished but remaining between 50% and 75% of
normal;
SEVERITY 3
15% or Frequent exacerbations caused by high urinary tract infections
(6 to 12 per year) despite treatments and medical follow-up (such as
with chronic pyelonephritis);

or Need for immunosuppressive treatments, including side effects, in
the case of a kidney transplant.


SEVERITY 4 Renal function diminished with clinical manifestations and a change
30% in general health. Retained renal function is less than 50% of
normal.


Renal function diminished with clinical manifestations and a change
SEVERITY 5 in general health. Retained renal function is less than 25% of
50% normal;

or Need for dialysis on a permanent basis.


Renal function diminished with a severe change in general health
SEVERITY 6 that is sufficient to confine the person to his or her room. The
90% person is entirely or almost entirely dependent on others for
performing most daily activities.



(21.2) MICTURITION
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as slight increase
MINIMUM in frequency or duration of micturition with no significant clinical
THRESHOLD impacts, are less than those resulting from the situation described
in Severity 1.


SEVERITY 1 Recurrent urinary tract infections despite medical treatments and
2% follow-up.


Trouble with micturition severe enough to justify regular treatments
or quarterly urethral dilations;
SEVERITY 2
5% or Urgent micturition or incontinence during coughing or exertion
sufficient to require protection to be worn on a regular basis but
insufficient to require regular use of diapers.


Trouble with micturition severe enough to justify monthly urethral
dilations, intermittent catheterization, or percussion micturition;

or Urinary incontinence in the form of significant daily leaking
SEVERITY 3 between micturitions sufficient to require the regular use of
10% diapers;

or Inconveniences related to the need of an artificial continence
sphincter;

or Inconveniences related to the need to implant a sacral stimulator.


Total urinary incontinence at the least effort or change in
position, and even at rest;

SEVERITY 4 or Inconveniences related to the need to leave a urethral catheter in
20% place;

or Inconveniences related to the need for an external urinary
derivation such as a subpubic cystostomy or an ileal bladder.


(22) GENITO-SEXUAL FUNCTIONS
The genito-sexual functions are used to accomplish sex acts for pleasure and/or procreation.
Genital sexual activity and procreation are occasionally complementary, but remain distinct in terms of their purpose. An impairment of one of these functions does not necessarily involve an impairment of the other. Termination of pregnancy is also taken into consideration when evaluating non-pecuniary damage, even when the procreation function is not permanently affected.
The genito-sexual functions are composed of three functional units.
(22.1) Genital Sexual Activity
(22.2) Procreation (this also refers to the ability to give birth)
(22.3) Termination of Pregnancy
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Impacts on genito-sexual functions resulting from paraplegia or quadriplegia must not be evaluated using the rules provided in this chapter but using the rules provided in the functional unit “Clinical Pictures of Paraplegia and Quadriplegia.”
(22.1) GENITAL SEXUAL ACTIVITY
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situation described in Severity 1.
THRESHOLD


SEVERITY 1 Trouble performing genital sexual activities that may be attenuated
1% by minor palliative measures such as the use of a lubricant.


Clinical manifestations such as pain in women during sexual
intercourse (dyspareunia) that make genital sexual activities more
SEVERITY 2 difficult;
5%
or Erectile dysfunction. Genital sexual activities remain possible with
oral medication or measures such as intracavernous injections,
intraurethral suppositories, or vacuum pumps.


SEVERITY 3 Need for a genital prosthesis in order to perform genital sexual
10% activities.


SEVERITY 4 Genital sexual activities are impossible despite all treatment
25% measures.


(22.2) PROCREATION
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment are less than those
MINIMUM resulting from the situation described in Severity 1.
THRESHOLD


Inconveniences related to the relative risk represented by the loss
SEVERITY 1 of a testicle or an ovary.
2%
Note: Compensation is only awarded if procreation was possible at
the time of the accident.


Ovulation difficult but possible with a specific medication such as
a fertility drug;

or Woman’s procreation function affected, but fertilization is still
possible with a specialized medical procedure such as artificial
insemination or in vitro fertilization;

SEVERITY 2 or Man’s procreation function affected (e.g., retrograde ejaculation)
5% but fertilization is still possible with a specialized medical
procedure;

or Inconveniences related to the need for a cesarean section to give
birth.

Note: This situation can only be accepted once, i.e., following the
first birth.


SEVERITY 3 Procreation is impossible despite all treatment measures.
25%


(22.3) TERMINATION OF PREGNANCY
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



SEVERITY 1 Loss of one embryo or fetus.
8%


SEVERITY 2 Loss of more than one embryo or fetus.
12%


(23) ENDOCRINE, HEMATOLOGICAL, IMMUNE, AND METABOLIC FUNCTIONS
The endocrine, hematological, immune, and metabolic functions play a role that has an impact on the functioning of the entire body.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



UNDER THE After-effects of the permanent impairment, such as biochemical or
MINIMUM hematological anomalies with no significant clinical impact, are
THRESHOLD less than those resulting from the situations described in
Severity 1.


Regular and permanent need

for medication, which may cause side effects;
SEVERITY 1
2% or

to take preventive measures and action due to a risk of
transmission of a viral infection or a risk of infection such as
following splenectomy.


Slight impairment to general health with frequent exacerbations,
fatigability, and a slight reduction of endurance;

SEVERITY 2 or The regular and permanent need to receive one or several
5% injections once or twice a day;

or The regular and permanent need to follow a restrictive diet
combined with medical treatments.


Moderate impairment to general health with asthenia. The problem
limits the ability to perform unaccustomed physical activities
or physical activities requiring significant effort such as
running or rapidly climbing a number of stairs. However, the
SEVERITY 3 person remains able to perform relatively demanding activities
15% such as walking long distances or climbing 2 floors at a
normal pace;

or Regular and permanent need to receive one or several injections
more than twice a day.


Significant impairment to general health with asthenia. The problem
limits the ability to perform many normal daily activities but the
SEVERITY 4 person remains able to perform moderate activities such as walking
30% at a normal pace or doing regular household chores, with the
exception of heavy work.


Severe impairment to general health with asthenia. Endurance is
SEVERITY 5 limited to light activities such as certain essential daily
60% activities like getting dressed, managing self care, and moving
around the home.


Very severe impairment to general health with asthenia. The person
SEVERITY 6 is totally or almost totally dependent on another person to perform
90% most daily activities and is practically confined to his or her
room.


(24) CLINICAL PICTURES OF PARAPLEGIA AND QUADRIPLEGIA
Paraplegia or quadriplegia resulting from a spinal cord injury has an impact on a number of bodily functions as well as a severe esthetic impact.
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) This chapter deals exclusively with the conditions of paraplegia or quadriplegia (neurological levels C1 to L5). All the impacts on any other functional unit resulting from paraplegia or quadriplegia are included in the categories of severity of this unit.
(3) Esthetic impairment that results from changes to form and contours (e.g., atrophy, contractures) or from the use of technical devices or aids (e.g., orthesis, urethral catheter, wheelchair) are included in the categories of severity of this unit.
(4) The preferred criterion for evaluating the impacts of paraplegia or quadriplegia on the performance of activities of daily living is residual functional potential. Motor level and functional potential are evaluated based on the criteria of the American Spinal Injury Association (ASIA) in “International Standards for Neurological and Functional Classification of Spinal Cord Injury, revised 1996.”
(5) For other medullary or radicular impairments, the impacts must be evaluated using the rules provided in the functional or esthetic units that specifically deal with the observed impacts, for example
— Medullary impairment at a neurological level under L5,
— Brown-Séquard syndrome, central medullary syndrome, anterior medullary syndrome,
— Cerebral impairment (hemiplegia),
— Peripheral nervous system impairment (compression of nerve roots, lumbar plexus impairment)
CATEGORIES OF SEVERITY


After-effects experienced in daily life - loss of enjoyment of life, mental
suffering, pain, and other consequences - resulting from a permanent impairment can
be compared with those that would result from the situation with maximum impact
among the following:



SEVERITY 1 Functional potential is equivalent to a motor level between D8 and
75% L5.


SEVERITY 2 Functional potential is equivalent to a motor level between D2 and
80% D7.


SEVERITY 3 Functional potential is equivalent to a motor level of C8 or D1.
85%


SEVERITY 4 Functional potential is equivalent to a motor level of C7.
90%


SEVERITY 5 Functional potential is equivalent to a motor level of C6.
95%


SEVERITY 6 Functional potential is equivalent to a motor level between C1 and
100% C5.


(25) ESTHETIC
Esthetic prejudice results from a deterioration in general appearance due to an impairment to the skin or to the form or contours of the body.
Esthetic is composed of eight units:
(25.1) Esthetic of the Skull and Scalp
(25.2) Esthetic of the Face
(25.3) Esthetic of the Neck
(25.4) Esthetic of the Trunk and Genital Organs
(25.5) Esthetic of the Right Upper Limb
(25.6) Esthetic of the Left Upper Limb
(25.7) Esthetic of the Right Lower Limb
(25.8) Esthetic of the Left Lower Limb
EVALUATION RULES
(1) See the provisions of Division II of the Regulation.
(2) Esthetic prejudice that becomes apparent when performing a function (such as limping, salivary incontinence), or that results from the use of technical devices or aids (such as orthosis, prosthesis) must not be evaluated using the rules provided in this chapter. This dynamic component is already taken into consideration in the percentages awarded for the categories of severity in each of the functional units that specifically deal with the observed impacts.
(3) In paraplegia or quadriplegia, esthetic prejudice resulting from changes to form and contours (such as atrophy, contractures) or from the use of technical devices or aids (such as orthosis, urethral catheter, wheelchair) must not be evaluated using the rules provided in this chapter. This component is already taken into consideration in the percentages awarded in the categories of severity of the functional unit “Clinical Pictures of Paraplegia and Quadriplegia.”
(4) Permanent esthetic impairment must not only be visible, it must be apparent, that is, it must be clearly visible at 50 cm. Any “apparent” impairment is taken into consideration despite the fact that it is normally hidden by clothing or hair.
(5) The following 4 categories of impairment are the retained criteria for the evaluation:
▸▸ Change in skin colour: hypopigmentation or hyperpigmentation due to damage to the superficial dermis. The deep dermis is not damaged. Suppleness, elasticity, hydration, and pilosity are retained.
▸▸ Flat scars: linear or almost linear, well oriented in the same direction as natural skin creases, at the same level as the adjoining tissue and almost the same colour. They do not cause contractures or distortion of neighboring structures.
▸▸ Faulty scars: linear or plaques, misaligned or cross over a natural skin crease. They may be irregular, depressed, deeply adhering, retractile, keloidal, hypertrophic, or pigmented.
▸▸ Change in shape and contours: disfigurement, tissue loss, atrophy, or amputation.
(6) The anatomical boundaries retained to separate contiguous parts of the body are the following:
▸▸ Skull and Scalp:
Region inside the normal, usual hairline. In the presence of baldness, the anatomical boundary corresponds to what would have been the normal hairline.
▸▸ Face:
Region defined by the anatomical boundaries of the skull and neck.
Fifteen (15) anatomical elements are used for the purposes of evaluating form and contours:
· Right half of forehead
· Left half of forehead
· Right orbit/eyelid
· Left orbit/eyelid
· Nose
· Right eye (visible part of the ocular globe)
· Left eye (visible part of the ocular globe)
· Right cheek
· Left cheek
· Mouth (visible part when open)
· Upper lip
· Lower lip
· Chin
· Right ear
· Left ear
▸▸ Neck:
Upper boundary: line following the lower part of the body of the mandible, continuing along the vertical rami to the temporomandibular joints and then along the normal usual hairline.
Lower boundary: line beginning at the jugular notch, continuing along the upper edge of the clavicle to the mid-point and then to the C7 spinous process.
▸▸ Trunk and Genital Organs:
Region defined by the anatomical boundaries of the neck , the upper limbs and the lower limbs
▸▸ Upper Limb (upper boundary):
Circular line beginning at the apex of the armpit, extending backwards and forwards, and ending at the mid-point of the clavicle.
▸▸ Lower Limb (upper boundary):
Line beginning at the median upper edge of the pubic symphysis, continuing obliquely to the antero-superior iliac spine, then along the upper edge of the iliac crest, and ending at the upper vertical boundary of the gluteal fold.
For each esthetic unit, the category of severity is determined by the result of the overall weighted evaluation. The evaluation is conducted in 4 steps:
Step 1: Describe all esthetic impairments found during the clinical evaluation.
Step 2: For each category of impairment (permanent changes to skin colour, flat scars, faulty scars, and changes to form and contours), determine the description corresponding to the result of the clinical evaluation. Only one score may be assigned per category of impairment.
Step 3: Add the scores.
Step 4: Determine the category of severity based on the appropriate correlation table.
(25.1) ESTHETIC OF THE SKULL AND SCALP
OVERALL WEIGHTED EVALUATION
Changes of Skin Color Flat Scars Faulty Scars Changes to Form and Contours, Non-Cicatricial Alopecia
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
< 15 cm2 }


Total length is
< 10 cm }





Linear, total length is
< 3 cm }


Area of non-cicatricial alopecia, total area is
< 2 cm2 }



and/or 0.5 0.5 and/or 0.5 0.5
area of color very different from neighboring skin, apparent at 3 m, total area is
< 2 cm2 plaques, total area is
< 2 cm2
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
Š 15 cm2 }


Total length is
Š 10 cm }




Linear, total length is
Š 3 cm but < 10 cm }



Area of non-cicatricial alopecia, total area is
Š 2 cm2 but < 2 cm2 }



and/or 2 2 and/or 2 and/or 2
area of color very different from neighboring skin, apparent at
3 m, total area is Š 2 cm2 but
< 5 cm2 plaques, total area is
Š 2 cm2 but < 5 cm2 slight disfigurement of the skull
Area of color very differente from neighboring skin, apparent at 3 m, }


Linear, total length is
Š 10 cm but < 25 cm }

Area of non-cicatricial alopecia, total area is Š 5 cm2 }


7 and/or 7 and/or 7
total area is Š 5 cm2 but
< 25% of the entire skull and scalp plaques, total area is
Š 5 cm2 but < 15 cm2 moderate disfigurement of the skull
Area of color very differente from neighboring skin, apparent at 3 m, }


Linear, total length is
Š 25 cm }



Significant disfigurement of the skull }

20 and/or 20 20
total area is Š 25% of the entire skull and scalp plaques, total area is
Š 15 cm2 but < 25% of the entire skull and scalp
Extensive and unsightly scars, total area is Š 25% of the entire skull and scalp } 40 Severe and unsightly disfigurement affecting almost the entire skull } 40
Total Weighted Evaluation: _____Points
(25.2) ESTHETIC OF THE FACE
OVERALL WEIGHTED EVALUATION
Changes of Skin Color Flat Scars Faulty Scars Changes to Form and Contours, Non-Cicatricial Alopecia
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
< 10 cm2 }


Total length is
< 5 cm }





Linear scars, total length is < 2 cm }


Slight disfigurement of 1 anatomical element* }



and/or 0.5 0.5 and/or 0.5 0.5
area of color very different from neighboring skin, apparent at 3 m, total area is
< 2 cm2 plaques, total area is
< 1 cm2
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
Š 10 cm2 }


Total length is
Š 5 cm but < 20 cm }




Linear scars, total length is Š 2 cm but
< 5 cm }




Slight disfigurement of 2 or more anatomical elements* }



and/or 2 2 and/or 2 and/or 2
area of color very different from neighboring skin, apparent at 3 m, total area is
Š 2 cm2 but < 5 cm2 plaques, total area is
Š 1 cm2 but < 3 cm2 moderate disfigurement of 1 anatomical element*
Area of color very different from neighboring skin, apparent at 3 m,
total area is Š 5 cm2 but
< 10 cm2 } Total length is
Š 20 cm } Linear scars, total length is Š 5 cm but
< 15 cm } Moderate disfigurement of 2 or more anatomical elements* }
7 7 and/or 7 and/or 7
plaques, total area is
Š 3 cm2 but < 10 cm2 significant disfigurement of 1 anatomical element*
Area of color very differente from neighboring skin, apparent at 3 m, }
Linear scars, total length is Š 15 cm }

Significant disfigurement of 2 or more anatomical elements* }
20 and/or 20 20
total area is Š 10 cm2 plaques, total area is
Š 10 cm2 but < 25% of the entire face
Extensive and conspicuous scars, total area is Š 25% but
< 50% of the entire face } 40 Severe and unsightly disfigurement affecting approximely 50% of the face } 40
Extensive and unsightly scars corresponding to disfiguration } 80 Deformation of almost the entire face corresponding to disfiguration } 80
*Note: See point 7 of evaluation rules in this chapter for the list of anatomical elements to be evaluated. Total Weighted Evaluation: _____Points
(25.3) ESTHETIC OF THE NECK
OVERALL WEIGHTED EVALUATION
Changes of Skin Color Flat Scars Faulty Scars Changes to Form and Contours, Non-Cicatricial Alopecia
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
< 10 cm2 }


Total length is
< 5 cm }





Linear scars, total length is < 2 cm }


Very slight disfigurement of the neck, apparent at
50 cm but not very apparent at 3 m }



and/or 0.5 0.5 and/or 0.5 0.5
area of color very different from neighboring skin, apparent at 3 m, total area is
< 2 cm2 plaques, total area is
< 1 cm2
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
Š 10 cm2 }


Total length is
Š 5 cm but < 20 cm }




Linear scars, total length is Š 2 cm but
< 5 cm }


Slight disfigurement of the neck }



and/or 2 2 and/or 2 2
area of color very different from neighboring skin, apparent at 3 m, total area is
Š 2 cm2 but < 5 cm2 plaques, total area is
Š 1 cm2 but < 3 cm2
Area of color very different from neighboring skin, apparent at 3 m, total area is
Š 5 cm2 but < 25% of the entire neck } Total length is
Š 20 cm } Linear scars, total length is Š 5 cm but
< 15 cm } Moderation disfigurement of the neck }

7
7 and/or
7
7
plaques, total area is
Š 3 cm2 but < 10 cm2
Area of color very differente from neighboring skin, apparent at 3 m, total area is
Š 25% of the entire neck }
Linear scars, total length is Š 15 cm } Significant disfigurement of the neck }

20 and/or
20
20
plaques, total area is
Š 10 cm2 but < 25% of the entire neck
Extensive and unsightly scars, total area is Š 25% of the entire neck } 40 Severe and unsightly disfigurement affecting almost the entire neck } 40
Total Weighted Evaluation: _____Points
(25.4) ESTHETIC OF THE TRUNK AND GENITAL ORGANS
OVERALL WEIGHTED EVALUATION
Changes of Skin Color Flat Scars Faulty Scars Changes to Form and Contours, Non-Cicatricial Alopecia
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
< 25 cm2 }


Total length is
< 10 cm }





Linear scars, total length is < 5 cm }


Very slight disfigurement of the trunk, apparent at
50 cm but not very apparent at 3 m }



and/or 0.5 0.5 and/or 0.5 0.5
area of color very different from neighboring skin, apparent at 3 m, total area is
< 5 cm2 plaques, total area is
< 5 cm2
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
Š 25 cm2 }


Total length is
Š 10 cm but < 25 cm }




Linear scars, total length is Š 5 cm but
< 10 cm }


Slight disfigurement of the trunk }



and/or 2 2 and/or 2 2
area of color very different from neighboring skin, apparent at 3 m, total area is
Š 5 cm2 but < 25 cm2 plaques, total area is
Š 5 cm2 but < 10 cm2
Area of color very different from neighboring skin, apparent at 3 m,
total area is Š 25 cm2 but
< 25% of the entire trunk }




7 Total length is
Š 25 cm }




7 Linear scars, total length is Š 10 cm but
< 25 cm }




7 Moderate disfigurement of the trunk }




7
and/or and/or of the genital organs
plaques, total area is
Š 10 cm2 but < 50 cm2 and/or of the breasts (woman only)
Area of color very different from neighboring skin, apparent at 3 m, total area is
Š 25% of the entire trunk }
Linear scars, total length is Š 25 cm } Significant disfigurement of the trunk }

20 and/or
20 and/or of the genital organs
20
plaques, total area is
Š 50 cm2 but < 25% of the entire trunk and/or of the breasts (woman only)
Extensive and unsightly scars, total area is Š 25% but
< 50% of the entire trunk } 40 Severe disfigurement of the trunk

and/or of the genital organs

and/or of the breasts (woman only) } 40
Extensive and unsightly scars, total area is Š 50% of the entire trunk } 80 Severe and unsightly disfigurement affecting almost the entire trunk } 80
Total Weighted Evaluation: _____Points
(25.5) ESTHETIC OF THE RIGHT UPPER LIMB
(25.6) ESTHETIC OF THE LEFT UPPER LIMB
OVERALL WEIGHTED EVALUATION
Changes of Skin Color Flat Scars Faulty Scars Changes to Form and Contours, Non-Cicatricial Alopecia
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
< 25 cm2 }


Total length is
< 10 cm }





Linear scars, total length is < 3 cm }


Very slight disfigurement of the trunk, apparent at
50 cm but not very apparent at 3 m }



and/or 0.5 0.5 and/or 0.5 0.5
area of color very different from neighboring skin, apparent at 3 m, total area is
< 5 cm2 plaques, total area is
< 2 cm2
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
Š 25 cm2 }


Total length is
Š 10 cm but < 25 cm }




Linear scars, total length is Š 3 cm but
< 5 cm }


Slight disfigurement of the limb, such as an amputation of 1 or 2 phalanges }



and/or 2 2 and/or 2 2
area of color very different from neighboring skin, apparent at 3 m, total area is
Š 5 cm2 but < 25 cm2 plaques, total area is
Š 2 cm2 but < 5 cm2
Area of color very different from neighboring skin, apparent at 3 m,
total area is Š 25 cm2 but
< 25% of the entire limb }




7 Total length is
Š 25 cm }




7 Linear scars, total length is Š 5 cm but
< 15 cm }




7 Moderate disfigurement of the limb such as an amputation of 1 or 2 fingers, or 1 or 2 metacarpals }




7
and/or
plaques, total area is
Š 5 cm2 but < 25 cm2
Area of color very different from neighboring skin, apparent at 3 m, total area is
Š 25% of the entire limb }
Linear scars, total length is Š 15 cm } Significant disfigurement of the limb such as an amputation of more than 2 fingers or 2 metacarpals }

20 and/or
20
20
plaques, total area is
Š 25 cm2 but < 25% of the entire limb
Extensive and unsightly scars, total area is Š 25% but
< 50% of the entire limb } 40 Severe and unsightly disfigurement of the limb as amputation at the wrist or forearm } 40
Extensive and unsightly scars, total area is Š 50% of the entire limb } 80 Severe and unsightly disfigurement of almost the entire limb such as the amputation at the arm } 80
Total Weighted Evaluation: _____Points
(25.7) ESTHETIC OF THE RIGHT LOWER LIMB
(25.8) ESTHETIC OF THE LEFT LOWER LIMB
OVERALL WEIGHTED EVALUATION
Changes of Skin Color Flat Scars Faulty Scars Changes to Form and Contours, Non-Cicatricial Alopecia
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
< 25 cm2 }


Total length is
< 10 cm }





Linear scars, total length is < 5 cm }


Very slight disfigurement of the limb, apparent at
50 cm but not very apparent at 3 m }



and/or 0.5 0.5 and/or 0.5 0.5
area of color very different from neighboring skin, apparent at 3 m, total area is
< 5 cm2 plaques, total area is
< 5 cm2
Area of color slightly different from neighboring skin, apparent at 50 cm but not very apparent at 3 m, total area is
Š 25 cm2 }


Total length is
Š 10 cm but < 25 cm }




Linear scars, total length is Š 5 cm but
< 10 cm }


Slight disfigurement of the limb, such as an amputation of 1 or 2 toes }



and/or 2 2 and/or 2 2
area of color very different from neighboring skin, apparent at 3 m, total area is
Š 5 cm2 but < 25 cm2 plaques, total area is
Š 5 cm2 but <10 cm2
Area of color very different from neighboring skin, apparent at 3 m, total area is
Š 25 cm2 but < 25% of the entire limb } Total length is
Š 25 cm } Linear scars, total length is Š 10 cm but
< 25 cm } Moderate disfigurement of the limb such as an amputation of more than 2 toes }

7
7 and/or
7
7
plaques, total area is
Š 10 cm2 but < 50 cm2
Area of color very differente from neighboring skin, apparent at 3 m, total area is
Š 25% of the entire limb }
Linear scars, total length is Š 25 cm } Significant disfigurement of the limb such as an amputation of a foot }

20 and/or
20
20
plaques, total area is
Š 50 cm2 but < 25% of the entire limb
Extensive and unsightly scars, total area is Š 25% but
< 50% of the entire limb } 40 Severe and unsightly disfigurement of almost the entire limb such as an amputation at ankle or lower leg } 40
Extensive and unsightly scars, total area is Š 50% of the entire limb } 80 Severe and unsightly disfigurement of almost the entire limb such as the amputation at thigh } 80
Total Weighted Evaluation:: _____Points
CATEGORIES OF SEVERITY
Under the Minimum Threshold
After-effects of the permanent impairment, such as a scar that is barely visible and not apparent at 50 cm, are less than those resulting from the situation described in Severity 1.
___________________________________________________________________________________

CATEGORIES OF SEVERITY ACCORDING TO THE RESULT OF THE OVERALL WEIGHTED EVALUATION
___________________________________________________________________________________
| | | | | | |
|Under the| 0.5 to 1 | 1.5 to 5 | 6 to 19 | 20 to 39 | 40 to 79 | 80 and
| Minimum | | | | | | over
|Threshold| | | | | |
| N/A* |SEVERITY 1|SEVERITY 2|SEVERITY 3|SEVERITY 4|SEVERITY 5|SEVERITY 6
________|_________|__________|__________|__________|__________|__________|__________
| | | | | |
25.1. | | | | | |
Skull | | | | | |
and | | | | | |
Scalp | N/A | 0.5% | 1% | 3% | 5% | 8%
________|_________|__________|__________|__________|__________|_____________________
| | | | | | |
25.2. | | | | | | |
Face | N/A | 1% | 3% | 7% | 15% | 30% | 50%
________|_________|__________|__________|__________|__________|__________|__________
| | | | | |
25.3. | | | | | |
Neck | N/A | 0.5% | 1% | 3% | 5% | 8%
________|_________|__________|__________|__________|__________|_____________________
| | | | | | |
25.4. | | | | | | |
Trunk | | | | | | |
and | | | | | | |
Genital | | | | | | |
Organs | N/A | 0.5% | 1% | 3% | 6% | 9% | 12%
________|_________|__________|__________|__________|__________|_________|___________
| | | | | | |
25.5. | | | | | | |
Right | | | | | | |
Upper | | | | | | |
Limb | N/A | 0.5% | 1% | 3% | 6% | 9% | 12%
________|_________|__________|__________|__________|__________|_________|___________
| | | | | | |
25.6. | | | | | | |
Left | | | | | | |
Upper | | | | | | |
Limb | N/A | 0.5% | 1% | 3% | 6% | 9% | 12%
________|_________|__________|__________|__________|__________|_________|___________
| | | | | | |
25.7. | | | | | | |
Right | | | | | | |
Lower | | | | | | |
Limb | N/A | 0.5% | 1% | 3% | 6% | 9% | 12%
________|_________|__________|__________|__________|__________|_________|___________
| | | | | | |
25.8. | | | | | | |
Left | | | | | | |
Lower | | | | | | |
Limb | N/A | 0.5% | 1% | 3% | 6% | 9% | 12%
________|_________|__________|__________|__________|__________|_________|___________
(*) Not applicable
O.C. 1370-2000, Sch. I.
SCHEDULE OF INJURIES
Title I: Head and Neck
Title II: Face
Title III: Thorax
Title IV: Abdomen and Pelvic Contents
Title V: Spinal Column
Title VI: Right Upper Limb
Title VII: Left Upper Limb
Title VIII: Right Lower Limb
Title IX: Left Lower Limb
Title X: Psychic System
Title XI: Total Body Surface
Title XII: Complications
Title I: Head and Neck

Severity Rating

· Burns see Title XI: Surface

· Contusions where skin is not broken
see Title XI: Surface

· Sprains
Cervical sprain see Title V: Spinal Column

· Fractures
Skull

Fracture of calvarium without intracranial trauma 3
Fracture of calvarium with intracranial trauma 6
Fracture of base without intracranial trauma 4
Fracture of base with intracranial trauma 6

Neck
Cervical spine fracture see Title V: Spinal Column
Fracture of larynx and/or trachea 6

· Dislocations without fracture
Dislocation of cervical veterbrae see Title V: Spinal Column

· Wounds
Trauma to the tympanum and/or eustachian tube
see Title II: Face
Laryngeal and/or tracheal wound 3
Thyroid gland wound 3
Pharyngeal wound 3
Other head and neck wounds see Title XI: Surface

· Intracranial trauma not associated with a skull fracture
Concussion
Mild craniocerebral trauma
(loss of consciousness for less than 30 minutes with Glasgow
Coma score of 13 or more and/or post-traumatic amnesia for less
than 24 hours) 2
Moderate or severe craniocerebral trauma 4
Cerebral contusion or laceration 6
Intracranial hemorrhage 6
Subarachnoid hemorrhage, extradural or subdural hematoma 6
Trauma to the labyrinth 4

· Cranial nerve damage
Damage to the olfactory nerve (I) 4
Damage to the optic nerve (II) and/or visual pathways 4
Damage to the common motor ocular nerves (III) 4
Damage to the trochlear (pathetic) nerve (IV) 4
Damage to the trigeminal nerve (V) 4
Damage to the abducens nerve (VI) 4
Damage to the facial nerve (VII) 4
Damage to the auditory nerve (VIII) 4
Damage to the glossopharyngeal nerve (IX) 4
Damage to the vagal nerve (X) 4
Damage to the spinal nerve (XI) 4
Damage to the hypoglossal nerve (XII) 4

· Blood vessel injuries
Carotid artery injury 5
Injury of the internal jugular vein 5
Other injuries to vessels of the head and/or neck 4

· Superficial trauma see Title XI: Surface
Cutaneous foreign body see Title XI: Surface

· Mental disorders see Title X: Psychic System

Title II: Face

Severity Rating

· Impairment of the eye and of its adjacent structures
Burn to the eye and its adjacent structures
see Title XI: Surface
Burn to the cornea and/or conjunctival sac 2
Contusion of orbital tissue 1
Eyeball contusion 1
Foreign body in the cornea 1
Foreign body in the conjunctival sac 1
Eyelid tear with impairment of the lacrimal ducts 3
Eyelid tear without impairment of the lacrimal ducts
see Title XI: Surface
Choroidal and/or retinal detachment 5
Traumatic enucleation 6
Hemorrhage of the iris or ciliary body 4
Vitreous hemorrhage 4
Hemorrhage and rupture of the choroid 4
Retinal or preretinal hemorrhage 2
Subconjunctival hemorrhage 1
Perforation of the eyeball 6
Trauma to the eyeball 5
Orbital wound 4
Superficial trauma of the cornea 1
Superficial trauma of the conjunctiva 1

· Burns
Burn to the mucous membrane of the mouth and/or pharynx 4
Burn to the eye
see Impairment of the eye and of its adjacent structures
Other burns see Title XI: Surface

· Contusions where skin is not broken
Eyeball contusion
see Impairment of the eye and of its adjacent structures
Other contusions see Title XI: Surface

· Foreign bodies
Foreign body in the ear 1
Foreign body in the mouth 1
Foreign body in the eye
see Impairment of the eye and of its adjacent structures
Cutaneous foreign bodies (superficial injury)
see Title XI: Surface

· Sprains
Sprain (displacement) of the nasal septum cartilage 2
Maxillary sprain 2

· Fractures
One or more broken teeth 2
Fracture of bones of the nose 3
Mandibule fracture 4
Fracture of the malar bone and/or maxilla 4
LeFort I-type fracture 4
LeFort II-type fracture 4
LeFort III-type fracture 5
Fracture of the orbital floor or lower orbital wall 4
Fracture of the palate and/or tooth sockets 3
Fracture of the orbit
(excluding fractures of the upper wall or orbital floor) 3

· Dislocation without fracture
Temporo-maxillary dislocation 3

· Wounds
Trauma of the tympanum and/or the eustachian tube 3
Injury of the internal parts of the mouth, including the tongue 2
Eyelid wound with impairment of the lacrimal ducts
see Impairment of the eye and of its adjacent structures
Eyelid wound without impairment of the lacrimal ducts
see Title XI: Surface
Eyeball wound
see Impairment of the eye and of its adjacent structures
Penetrating orbital wound
see Impairment of the eye and of its adjacent structures
Other facial wounds see Title XI: Surface

· Nerve damage
Damage to superficial nerves of head and/or neck 2
Cranial nerve damage see Title I: Head and Neck

· Superficial injuries see Title XI: Surface
Cutaneous foreign bodies see Title XI: Surface

Title III: Thorax

Severity Rating

· Burns
Internal burn of the larynx, trachea or lung 4
Other burns see Title XI: Surface

· Contusions where skin is not broken
see Title XI: Surface

· Foreign bodies
Foreign body in the respiratory apparatus, excluding the lung 4
Foreign body in the lung 6
Cutaneous foreign bodies (superficial injury)
see Title XI: Surface

· Sprains
Sprain of the chondrocostal articulation 3
Sprain of the chrondrosternal articulation 3
Thoracic sprain see Title V: Spinal Column

· Fractures
Rib fracture
Fracture of 1 or 2 ribs 3
Fracture of three or more ribs 4
Flail chest-type fracture 6
Sternum fracture 4

· Dislocations without fracture
Sternoclavicular dislocation 4

· Wounds see Title XI: Surface

· Internal chest injuries
Hemothorax 4
Pneumohemothorax 4
Pneumothorax 4
Acute myocardial infarction 6
Trauma of the heart 6
Pulmonary contusion with or without pleural effusion 3
Trauma of the lung with penetrating chest wound 6
Trauma of the diaphragm 6
Trauma of another intrathoracic organ
(bronchi, oesophagus, pleura or thymus) 6

· Nerve damage
Trauma of one or more nerves of the trunk 4

· Blood vessel damage
Damage to the thoracic aorta 6
Damage to the brachiocephalic artery and/or subclavian artery 6
Damage to the superior vena cava 6
Damage to the brachiocephalic vein and/or subclavian vein 6
Damage to pulmonary vessels (artery and/or vein) 6
Damage to other thoracic blood vessels (intercostal or thoracic) 4

· Superficial injuries see Title XI: Surface
Cutaneous foreign bodies see Title XI: Surface

Title IV: Abdomen and Pelvic Contents

Severity Rating

· Burns see Title XI: Surface

· Contusions where skin is not broken
see Title XI: Surface

· Foreign bodies
Foreign body in the digestive apparatus 4
Cutaneous foreign body (superficial injury)
see Title XI: Surface

· Sprains
Back and/or lumbar sprain
see Title V: Spinal Column

· Pregnancy and childbirth
Premature delivery or miscarriage 6
Pregnancy complication 5

· Dislocations
Dislocation in the pelvic region
see Titles VIII and IX: Lower Limbs

· Wounds see Title XI: Surface

· Injury to internal organs of the abdomen and pelvis
Damage to the stomach 4
Damage to the small intestine 4
Damage to the large intestine and/or rectum 4
Damage to the pancreas 4
Damage to the liver 4
Damage to the spleen 4
Damage to the kidney 4
Damage to the bladder and/or to the urethra 4
Damage to the ureter 4
Damage to internal genital organs 4
Damage to other intra-abdominal organs
(gall bladder, cystic ducts, peritoneum, adrenal gland) 4

· Damage to external genital organs
Amputation of the penis 6
Amputation of the testicle(s) 6
Vaginal injury 3
Other wounds of the external genital organs
see Title XI: Surface

· Abdominal wall, inguinal or femoral trauma
Inguinal or femoral hernia 4
Epigastric or umbilical hernia 4

· Blood vessel damage
Damage to the abdominal aorta 6
Damage to the inferior vena cava 6
Damage to the celiac trunk and/or mesenteric arteries 6
Damage to the portal vein and/or splenic vein 6
Damage to renal blood vessels 6
Damage to iliac blood vessels 6

· Superficial injuries see Title XI: Surface
Cutaneous foreign bodies see Title XI: Surface

Title V: Spinal Column

Severity Rating
· Sprains
Cervical or cervicothoracic sprain
Cervical sprain without objective clinical sign (cervicalgia, WAD I ) 1
Cervical sprain with musculoskeletal signs (WAD II ) 2
Cervical sprain with neurological signs (WAD III ) 4
Thoracic or thoracolumbar sprain
Thoracic or thoracolumbar sprain without objective
clinical sign (dorsalgia) 1
Thoracic or thoracolumbar sprain with musculoskeletal signs 2
Thoracic or thoracolumbar sprain with neurological signs 4
Lumbar or lumbosacral sprain
Lumbar or lumbosacral sprain without objective
clinical sign (lumbago) 1
Lumbar or lumbosacral sprain with musculoskeletal signs 2
Lumbar or lumbosacral sprain with neurological signs 4
Sacral sprain 2
Coccygeal sprain 2

· Fractures
Cervical spine

Fracture of one or more cervical vertebrae without neurological lesion 5
Fracture of one or more cervical vertebrae with neurological lesion 6

Thoracic spine
Fracture of one or more thoracic vertebrae without neurological lesion 4
Fracture of one or more thoracic vertebrae with neurological lesion 6

Lumbar and sacral spine
Fracture of one or more lumbar vertebrae without neurological lesion 5
Fracture of one or more lumbar vertebrae with neurological lesion 6
Fracture of the sacrum and/or coccyx without neurological lesion 4
Fracture of the sacrum and/or coccyx with neurological lesion 6

· Dislocations without fracture
Dislocation of one cervical vertebra 5
Dislocation of one thoracic and/or lumbar vertebra 5

· Isolated injury to the spinal cord
Spinal cord injury of the cervical spine without vertebral lesion 6
Spinal cord injury of the thoracic spine without vertebral lesion 6
Spinal cord injury of the lumbar spine without vertebral lesion 6
Spinal cord injury of the sacral spine without vertebral lesion 6

· Damage to the roots and rachidian plexus
Damage to one or more cervical roots 4
Damage to one or more thoracic roots 4
Damage to one or more lumbar roots 4
Damage to one or more sacral roots 4
Damage to the brachial plexus 6
Damage to the lumbosacral plexus 6

· Other impairments of the spine
Herniated cervical disc 5
Herniated thoracic, lumbar or lumbosacral disc 5
Acquired spondylolisthesis 4

Title VI: Right Upper Limb
Title VII: Left Upper Limb

Severity Rating

· Amputations
Amputation of a thumb 5
Amputation of finger(s) other than the thumb 5
Amputation of the arm or hand
(excluding the isolated amputation of finger(s) or thumb) 6

· Musculotendinous impairment
Rotator cuff syndrome 3
Rupture of the rotator cuff 4
Tendinitis of the elbow 3
Tendinitis of the wrist 3

· Burns see Title XI: Surface

· Contusions where skin is not broken see Title XI: Surface

· Sprains
Acromioclavicular sprain 3
Shoulder sprain 3
Elbow sprain 3
Wrist sprain 3
Hand sprain 2

· Fractures
Clavicle fracture 4
Scapula fracture 4
Fracture of the upper epiphysis of the humerus 5
Diaphyseal fracture of the humerus 4
Inferior epiphyseal fracture of the humerus 5
Superior epiphyseal fracture of the radius and/or ulna 5
Diaphyseal fracture of the radius and/or ulna 4
Inferior epiphyseal fracture of the radius and/or ulna 5
Fracture of the carpus 4
Fracture of one or more metacarpals 4
Fracture of one or more phalanges of the fingers 3

· Dislocations without fracture
Shoulder dislocation 4
Elbow dislocation 4
Dislocation of the wrist 4
Finger dislocation (one or more) 3

· Wounds
Traumatic arthrotomy of the elbow 4
Wound(s) without damage to tendons see Title XI: Surface
Wound(s) to arm, excluding wrist and hand, with damage to tendons 4
Wound(s) to wrist, hand and/or fingers with damage to tendons 5

· Nerve damage
Damage to the circumflex nerve 4
Damage to the median nerve 4
Damage to the ulnar nerve 4
Damage to the radial nerve 4
Damage to the musculocutaneous nerve of the arm 3
Damage to the cutaneous nerves of the arm 3
Damage to the collateral palmar nerves (digital nerves) 3

· Blood vessel damage
Damage to the blood vessels in the arm
(axillary, brachial, radial, cubital) 4

· Superficial injuries see Title XI: Surface
Cutaneous foreign bodies see Title XI: Surface

Title VIII: Right Lower Limb
Title IX: Left Lower Limb

Severity Rating


· Amputations
Amputation of toes 4
Amputation of the leg, excluding the isolated amputation of toe(s) 6

· Musculotendinous impairment
Tendinitis of the hip 3
Tendinitis of the knee 3
Tendinitis of the ankle and/or foot 3

· Impairment of menisci
Tear of one or more menisci of the knee 3

· Burns see Title XI: Surface

· Contusions where skin is not broken see Title XI: Surface

· Sprains
Hip sprain 3
Knee sprain 3
Ankle sprain 3
Foot sprain 2
Sacroiliac sprain 3
Pelvic sprain (pubic symphysis) 3

· Fractures
Fracture of the acetabulum 5
Fracture of the pubis 4
Fracture of the ilium and/or ischium 4
Multiple fractures of the pelvis 5
Fracture of femoral neck 5
Diaphyseal fracture of the femur 5
Inferior epiphyseal fracture of the femur 5
Fracture of the patella 4
Superior epiphyseal fracture of the tibia and/or fibula 5
Diaphyseal fracture of the tibia and/or fibula 4
Ankle fracture 4
Calcaneal fracture 4
Fracture of the talus 4
Fractures of other bones of the tarsus and/or metatarsus 4
Fracture of one or more phalanges of the toes 3

· Dislocations without fracture
Dislocation in the pelvis 4
Dislocation of the hip 5
Dislocation of the patella 3
Dislocation of the knee 6
Dislocation of the ankle 4
Dislocation of the foot 3

· Wounds
Traumatic arthrotomy of the knee 4
Traumatic arthrotomy of the ankle 4
Leg wound, without damage to tendons see Title XI: Surface
Leg wound, with damage to tendons 4

· Nerve damage
Damage to the sciatic nerve 5
Damage to the crural nerve 4
Damage to the posterior tibial nerve 4
Damage to the common fibular nerve 4
Damage to the cutaneous nerves of the leg 3

· Blood vessel damage
Damage to the common and/or superficial femoral artery 6
Damage to the femoral and/or saphenous veins 4
Damage to popliteal blood vessels 4
Damage to tibial blood vessels 4

· Superficial injuries see Title XI: Surface
Cutaneous foreign bodies see Title XI: Surface

Title X: Psychic System*

Severity Rating

Anxiety 2
Reactive depression 4
Acute reactive state resulting from a difficult situation 4
Neurosis or psychoneurosis 4

* For psychic system complications resulting from an injury, see Title 12: Complications

Title XI: Total Body Surface

Severity Rating

· Burns
Head, face and neck

Burn to the cornea or conjunctival sac see Title II: Face
Unspecified burn to the eye and its adjacent structures 2
Burn to the eyelid and/or periocular region 2
First-degree burn to the head and/or neck 2
Second-degree burn to the head and/or neck 3
Deep second-degree burn to the head and/or neck 4
Third-degree burn to the head and/or neck 5
Internal burn to the larynx, trachea and/or lung
see Title III: Thorax

Trunk
First-degree burn to the trunk 2
Second-degree burn to the trunk 3
Deep second-degree burn to the trunk 4
Third-degree burn to the trunk 5

Arm
First-degree burn to an arm 2
Second-degree burn to an arm 3
Deep second-degree burn to an arm 4
Third-degree burn to an arm 5

Leg
First-degree burn to a leg 2
Second-degree burn to a leg 3
Deep second-degree burn to a leg 4
Third-degree burn to a leg 5

Multiple or extensive burns
Burn(s) covering less than 10% of the body
see the specific region
Burns covering 10% to 19% of the body 6
Burns covering 20% to 29% of the body 6
Burns covering 30% to 39% of the body 6
Burns covering 40% to 49% of the body 6
Burns covering 50% to 59% of the body 6
Burns covering 60% to 69% of the body 6
Burns covering 70% to 79% of the body 6
Burns covering 80% to 89% of the body 6
Burns covering 90% to 99% of the body 6

· Contusions where skin is not broken
Multiple-site contusions 1

Head - face and neck
Contusion of the face, scalp and/or neck 1
Contusion of the eyelid and/or the periocular region 1
Contusion of orbital tissue see Title II: Face
Contusion of the eyeball see Title II: Face

Trunk
Breast contusion 1
Contusion of the front chest wall 1
Contusion of the abdominal wall 1
Contusion of the posterior wall of trunk 1
Contusion of genital organs 2
Multiple contusions to the trunk 1

Arm
Arm contusion(s) 1

Leg
Leg contusion(s) 1

· Foreign bodies
Cutaneous foreign bodies see Superficial injuries

· Wounds
Multiple-site wounds 2

Head, face and neck
Tear of the eyelid and/or periocular region, without
impairment of the lacrimal ducts 2
Tear of the eyelid with impairment of the lacrimal ducts
see Title II: Face
Head wound, excluding face 2
Facial wound 2
Outer ear injury 2
Wound of the tympanum and/or eustachian tube
see Title II: Face
Eyeball wound see Title II: Face
Penetrating orbital wound see Title II: Face
Neck wound 2

Trunk
Wound of the front chest wall 2
Wound of the posterior wall of the trunk 2
Wound of external genital organs 3
Wound of the front and/or side abdominal wall 2
Wound of the perineum 2
Vaginal wound see Title IV: Abdomen and Pelvic Contents

Arm
Arm wound(s) with tendon impairment
see Titles VI - VII: Upper Limbs
Arm wound(s) 2

Leg
Leg wound(s) with tendon impairment
see Titles VIII - IX: Lower Limbs
Leg wound(s) 2

· Superficial injuries
(abrasions, scratches, friction burns, foreign body (splinter)
without major wound)

Superficial injury to the face, neck and/or scalp 1
Superficial injury to the trunk 1
Superficial injury to an arm 1
Superficial injury to a leg 1
Superficial injuries at multiple sites 1

Title XII: Complications

Severity Rating

Injury resulting in death (more than 24 hours after the accident) 6
Stroke 6
Cardiopulmonary arrest 6
Traumatic shock (hypovolemic shock) 6
Post-operative shock 6
Coagulopathy 4
Peripheral vascular complications 4
Volkmann’s ischemic contracture 5
Reflex sympathetic dystrophy 6
Cerebral embolism 6
Pulmonary embolism 6
Traumatic subcutaneous emphysema 3
Psychotic state 4
Myocardial infarction 6
Infection of a wound 3
Post-operative infection 5
Lung failure 6
Kidney failure 5
Carbon monoxide poisoning 2
Pulmonary edema 5
Acute pericarditis 6
Compartmental syndrome 5
Paroxysmal tachycardia 6
Peptic ulcer 4
O.C. 1370-2000, Sch. II.
REFERENCES
O.C. 1370-2000, 2000 G.O. 2, 5443