A-25, r. 2.1 - Regulation respecting catastrophic injuries or sequelae

Updated to 26 May 2022

This document has official status.

not in force

chapter A-25, r. 2.1

Regulation respecting catastrophic injuries or sequelae

Automobile Insurance Act

(chapter A-25, s. 26.2).

1. Catastrophic injuries or sequelae are determined by evaluating the victim’s condition 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.

S.Q. 2022, c. 13, s. 91.

2. The evaluation must consider the injuries and sequelae previously suffered in an accident or relapse.

S.Q. 2022, c. 13, s. 91.

3. In the case of a sequela, the evaluation is made in accordance with the evaluation rules set out in the Schedule of Permanent Functional and Esthetic Impairments to the Regulation respecting lump-sum compensation for non-pecuniary damage (chapter A-25, r. 10), except the rules referring to the provisions of Division II of that Regulation.

The evaluation must, according to the terms provided for in the first paragraph of section 6 of that Regulation, identify the functional or esthetic units impaired and determine the category of severity that represents the victim’s situation and the percentage corresponding to that category. However, if the victim had sequelae prior to the accident or relapse, the percentage corresponding to the category of severity of the functional or esthetic unit representative of the situation prior to the accident does not have to be deducted if the accident or relapse resulted in the aggravation of the victim’s prior sequelae.

The category of severity of the impaired functional or esthetic unit is determined by the situation having the greatest impact from among the situations corresponding to the result of the permanent sequelae evaluation. Only one category of severity may be determined for each impaired unit and the percentage corresponding to that category may only be awarded once.

S.Q. 2022, c. 13, s. 91.

4. The result of the evaluation must be explainable by accepted medical knowledge supported by objective data found on clinical examination.

S.Q. 2022, c. 13, s. 91.

5. Injuries or sequelae are catastrophic if the evaluation establishes that the victim

(1)  has third-degree burns that impair 2 or more functional units or the unit related to the esthetic of the face provided for in the Schedule, for which the combined percentages corresponding to the categories of severity for the units concerned add up to at least 75%;

(2)  has undergone 2 or more of the following amputations, on different limbs, including at least one mentioned in subparagraphs a and b:

(a)  above-elbow amputation;

(b)  above-knee amputation;

(c)  elbow disarticulation;

(d)  below-the-elbow amputation of the forearm;

(e)  wrist disarticulation;

(f)  knee disarticulation; or

(g)  below-the-knee amputation of the leg;

(3)  has one or more of the following functional alterations of the brain, for which the combined percentages corresponding to the categories of severity of the functional units provided for in the Schedule add up to at least 50%:

(a)  an impairment of the cognitive function corresponding to categories of severity 2 to 6 of functional unit 1 provided for in the Schedule, for which the percentage corresponding to those categories varies from 5% to 100%;

(b)  a disturbance of the state of consciousness corresponding to categories of severity 2 to 5 of functional unit 2 provided for in the Schedule, for which the percentage corresponding to those categories varies from 15% to 100%; or

(c)  an impairment of the cognitive aspect of language corresponding to categories of severity 2 to 5 of functional unit 3 provided for in the Schedule, for which the percentage corresponding to those categories varies from 20% to 100%;

(4)  has an affective or mental disorder corresponding to category of severity 5 or 6 of functional unit 1 provided for in the Schedule;

(5)  has a functional loss of vision corresponding to category of severity 85 of functional unit 4.1 provided for in the Schedule;

(6)  suffers from paraplegia or quadriplegia (motor level between cervical vertebra C1 and lumbar vertebra L5) corresponding to categories of severity 1 to 6 of functional unit 24 provided for in the Schedule; or

(7)  has 2 or more of the following impairments, for which the combined percentages corresponding to the categories of severity of the functional units provided for in the Schedule add up to at least 85%:

(a)  an affective or mental disorder corresponding to category of severity 4 of functional unit 1 provided for in the Schedule, for which the percentage corresponding to that category is 35%;

(b)  a functional loss of vision corresponding to categories of severity 45 to 84 of functional unit 4.1 provided for in the Schedule, for which the percentage corresponding to those categories varies from 45% to 84%;

(c)  an impairment of the cardio-respiratory function corresponding to categories of severity 4 to 8 of functional unit 20 provided for in the Schedule, for which the percentage corresponding to those categories varies from 20% to 100%; or

(d)  one or more of the following functional impairments, of orthopedic or neurological origin or resulting from the ablation of one or more internal organs, for which the combined percentages corresponding to the categories of severity of the functional units provided for in the Schedule add up to at least 30%:

i.  an impairment of the cognitive function corresponding to categories of severity 4 to 6 of functional unit 1 provided for in the Schedule, for which the percentage corresponding to those categories varies from 35% to 100%,

ii.  a disturbance of the state of consciousness corresponding to categories of severity 1 to 5 of functional unit 2 provided for in the Schedule, for which the percentage corresponding to those categories varies from 5% to 100%,

iii.  an impairment of the cognitive aspect of language corresponding to categories of severity 1 to 5 of functional unit 3 provided for in the Schedule, for which the percentage corresponding to those categories varies from 5% to 100%,

iv.  a balance disorder corresponding to categories of severity 3 to 6 of functional unit 8 provided for in the Schedule, for which the percentage corresponding to those categories varies from 15% to 100%,

v.  a phonation impairment corresponding to categories of severity 3 to 5 of functional unit 9 provided for in the Schedule, for which the percentage corresponding to those categories varies from 10% to 30%,

vi.  an impairment of the ability to move and maintain the position of the head corresponding to category of severity 4 or 5 of functional unit 11 provided for in the Schedule, for which the percentage corresponding to those categories varies from 15% to 30%,

vii.  an impairment of the ability to move and maintain the position of the trunk corresponding to category of severity 4 or 5 of functional unit 12 provided for in the Schedule, for which the percentage corresponding to those categories varies from 15% to 30%,

viii.  an impairment of the ability to move and maintain the position of an upper limb corresponding to categories of severity 5 to 7 of functional unit 13 provided for in the Schedule, for which the percentage corresponding to those categories varies from 15% to 30%,

ix.  a manual dexterity impairment corresponding to categories of severity 5 to 8 of functional unit 14 provided for in the Schedule, for which the percentage corresponding to those categories varies from 12% to 50%,

x.  a locomotion impairment corresponding to categories of severity 4 to 7 of functional unit 15 provided for in the Schedule, for which the percentage corresponding to those categories varies from 20% to 60%,

xi.  an impairment of ingestion corresponding to categories of severity 4 to 6 of functional unit 19.1 provided for in the Schedule, for which the percentage corresponding to those categories varies from 10% to 40%,

xii.  an impairment of digestion and absorption corresponding to categories of severity 3 to 6 of functional unit 19.2 provided for in the Schedule, for which the percentage corresponding to those categories varies from 10% to 50%,

xiii.  an impairment of excretion corresponding to categories of severity 3 to 5 of functional unit 19.3 provided for in the Schedule, for which the percentage corresponding to those categories varies from 10% to 40%,

xiv.  an impairment of the hepatic and biliary functions corresponding to categories of severity 3 to 5 of functional unit 19.4 provided for in the Schedule, for which the percentage corresponding to those categories varies from 10% to 40%,

xv.  an impairment of the renal function corresponding to categories of severity 4 to 6 of functional unit 21.1 provided for in the Schedule, for which the percentage corresponding to those categories varies from 30% to 90%, or

xvi.  a micturition impairment corresponding to category of severity 3 or 4 of functional unit 21.2 provided for in the Schedule, for which the percentage corresponding to those categories varies from 10% to 20%.

S.Q. 2022, c. 13, s. 91.

REFERENCES

S.Q. 2022, c. 13, s. 91