A-25, r. 14 - Regulation respecting the reimbursement of certain expenses

Schedule Disposition versions

2012-09-01

SCHEDULE I

(ss. 1 and 4)

LIST OF INJURIES

The figure “1” indicates an injury for which the personal home assistance requirements must be evaluated in accordance with the criteria prescribed in Schedule I.1.

The figure “2” indicates an injury for which the expenses incurred for personal home assistance requirements are reimbursed in accordance with the terms and conditions prescribed in section 4 of this Regulation, subject to the cases specified in section 2.

The figure “3” indicates an injury that is not considered for the purposes of personal home assistance.

In cases where an injury is not listed, a similar injury of equivalent severity shall be considered.

Region 1A: Arms and/or thorax (left side)

Region 1B: Arms and/or thorax (right side)

• Amputations
Amputation of a thumb                                                     2
Amputation of finger(s) other than the thumb                              2
Amputation of the arm or hand (excluding the
isolated amputation of finger(s) or thumb)                                1

• Musculotendinous impairment
Rotatar cuff syndrome                                                     2
Rupture of the rotator cuff                                               2
Tendinitis of the elbow                                                   2
Tendinitis of the wrist or the hand                                       2

• Burns
First-degree burn to the trunk                                            3
Second-degree burn to the trunk                                           1
Deep second-degree burn to the trunk                                      1
Third-degree burn to the trunk                                            1
First-degree burn to an arm                                               3
Second-degree burn to an arm                                              1
Deep second-degree burn to an arm                                         1
Third-degree burn to an arm                                               1

• Contusions where skin is not broken
Contusion of the front chest wall                                         3
Arm contusion(s)                                                          3
Breast contusion                                                          3
Multiple contusions to the trunk                                          3

• Complications
Peripheral vascular complications of the arm                              2
Volkmann’s ischemic contracture                                           2
Reflex sympathetic dystrophy of the arm                                   2
Pulmonary embolism                                                        3
Pulmonary insufficiency                                                   1
Pulmonary edema                                                           1
Acute pericarditis                                                        1
Compartmental syndrome of the arm                                         2
Paroxysmal tachycardia                                                    1
Thoracotomy                                                               2

• Sprains
Acromioclavicular sprain                                                  2
Sprain of the chondrocostal articulation                                  2
Sprain of the chondrosternal articulation                                 2
Elbow sprain                                                              2
Shoulder sprain                                                           2
Wrist sprain                                                              2
Thumb sprain                                                              2

• Fractures

Thorax
Fracture of one or two ribs                                               2
Fracture of three or more ribs                                            2
Sternum fracture                                                          2
Flail chest-type fracture                                                 2

Arm
Scapula fracture                                                          2
Clavicle fracture                                                         2
Fracture of the carpus                                                    2
Fracture of one or more metacarpals                                       2
Fracture of one or more phalanges of the fingers                          2
Fracture of the upper epiphysis of the humerus                            2
Diaphyseal fracture of the humerus                                        2
Inferior epiphyseal fracture of the humerus                               2
Superior epiphyseal fracture of the radius or ulna                        2
Diaphyseal fracture of the radius or ulna                                 2
Inferior epiphyseal fracture of the radius or ulna                        2

• Dislocations without fracture
Shoulder dislocation including acromioclavicular dislocation              2
Finger dislocation (one or more)                                          2
Elbow dislocation                                                         2
Dislocation of the wrist                                                  2
Sternoclavicular                                                          2

• Wounds
Traumatic arthrotomy of the arm                                           2
Wound(s) to arm                                                           3
Wound(s) to wrist, hand or fingers with damage to tendons                 2
Wound(s) to arm, excluding wrist and hand, with damage to tendons         2
Wound(s) to the hand or elbow requiring a cast                            2
Wound of the front chest wall                                             3

• Internal chest injuries
Pulmonary contusion with or without pleural effusion                      3
Hemothorax                                                                3
Pneumohemothorax                                                          3
Pneumothorax                                                              3
Acute myocardial infraction                                               1
Trauma of the lung with penetrating chest wound                           1
Trauma of the diaphragm                                                   1
Trauma of another intrathoracic organ
(bronchi, oesophagus, pleura or thymus)                                   1
                                                                      
• Blood vessel damage
Damage to the thoracic aorta                                    See related injuries
Damage to the brachiocephalic artery or subclavicular artery    See related injuries
Damage to the superior vena cava                                See related injuries
Damage to the brachio-cephalic vein or subclavicular vein       See related injuries
Damage to the blood vessels in the arm (axillary, brachial, 
radial, cubital)                                                See related injuries
Damage to pulmonary vessels (artery and/or vein)                See related injuries

• Superficial injuries
Superficial injury to the arm                                             3
Superficial injury to the trunk                                           3

• Nerve damage
Damage to the circumflex nerve                                            1
Damage to the median nerve                                                1
Damage to the ulnar nerve                                                 1
Damage to the radial nerve                                                1
Damage to the musculocutaneous nerve of the arm                           1
Damage to the cutaneous nerves of the arm                                 3
Damage to the collateral palmar nerves (digital nerves)                   1
Damage to the brachial plexus                                             1

Region 2A: Left leg
Region 2B: Right leg

• Amputations
Amputation of toes                                                        1
Amputation of the leg, excluding the isolated amputation of toe(s)        1

• Musculotendinous impairment
Tendinitis of the hip                                                     2
Tendinitis of the knee                                                    2
Tendinitis of the ankle and/or foot                                       2

• Impairment of menisci
Tear of one or more menisci of the knee                                   2

• Burns	
First-degree burn to a leg                                                3
Second-degree burn to a leg                                               1
Deep second-degree burn to a leg                                          1
Third-degree burn to a leg                                                1

• Complications
Peripheral vascular complications of the leg                              2
Reflex sympathetic dystrophy of the leg                                   2
Compartmental syndrome of the leg                                         2

• Contusions where skin is not broken
Contusion(s) of the leg                                                   3

• Sprains
Hip sprain                                                                2
Knee sprain                                                               2
Ankle sprain                                                              2
Foot sprain                                                               2

• Fractures
Fracture of the acetabulum                                                2
Fracture of femoral neck                                                  2
Diaphyseal fracture of the femur                                          2
Inferior epiphyseal fracture of the femur                                 2
Fracture of the patella                                                   2
Superior epiphyseal fracture of the tibia and/or fibula                   2
Diaphyseal fracture of the tibia and/or fibula                            2
Ankle fracture                                                            2
Calcaneal fracture                                                        2
Fracture of the talus                                                     2
Fractures of other bones of the tarsus and/or metatarsus                  2
Fracture of one or more phalanges of the toes                             2

• Dislocations without fracture
Dislocation of the hip                                                    2
Dislocation of the patella                                                2
Dislocation of the knee                                                   2
Dislocation of the ankle                                                  2
Dislocation of the foot                                                   2

• Wounds
Traumatic arthrotomy of the knee                                          2
Traumatic arthrotomy of the ankle                                         2
Wound(s) to the ankle or knee requiring a cast                            2
Leg wound(s), with damage to tendons                                      2
Leg wound(s)                                                              3

• Nerve damage
Damage to the sciatic nerve                                               1
Damage to the crural nerve                                                1
Damage to the posterior tibial nerve                                      1
Damage to the common fibular nerve                                        1
Damage to the lumbosacral plexus                                          1
Damage to the cutaneous nerves of the leg                                 3

• Blood vessel damage
Damage to the common and/or superficial femoral artery          See related injuries
Damage to the femoral and/or
saphenous veins                                                 See related injuries
Damage to popliteal blood vessels                               See related injuries
Damage to tibial blood vessels                                  See related injuries

• Superficial injuries
Superficial injury to a leg                                               3

Region 3A: Spinal column (fracture or dislocation)
Region 3B: Spinal column (hernia or sprain)

• Contusions
Contusion of the posterior wall of the trunk                              3

• Sprains
Cervical or cervicothoracic sprain
Cervical sprain without objective clinical 
sign (cervicalgia, WAD I)                                                 3
Cervical sprain with musculoskeletal signs (WAD II)                       2
Cervical sprain with neurological signs (WAD III)                         2
Thoracic or thoracolumbar sprain
Thoracic or thoracolumbar sprain without
objective clinical sign (dorsalgia)                                       3
Thoracic or thoracolumbar sprain with musculoskeletal signs               2
Thoracic or thoracolumbar sprain with neurological signs                  2
Lumbar or lumbosacral sprain 
Lumbar or lumbosacral sprain without 
objective clinical sign (lumbago)                                         3
Lumbar or lumbosacral sprain with musculoskeletal signs                   2
Lumbar or lumbosacral sprain with neurological signs                      2
Sacral sprain                                                             2
Coccygeal sprain                                                          2

• Fractures
Cervical spine
Fracture of one or more cervical vertebrae
without neurological lesion                                               2
Fracture of one or more cervical vertebrae
with neurological lesion                                                  1

Thoracic spine
Fracture of one or more thoracic vertebrae without neurological lesion    2
Fracture of one or more thoracic vertebrae with neurological lesion       1
Lumbar and sacral spine
Fracture of one or more lumbar vertebrae without neurological lesion      2
Fracture of one or more lumbar vertebrae with neurological lesion         1
Fracture of the sacrum and/or coccyx without neurological lesion          2
Fracture of the sacrum and/or coccyx with neurological lesion             1

• Dislocations without fracture
Dislocation of one cervical vertebra                                      2
Dislocation of one thoracic and/or lumbar vertebra                        2

• Wounds
Wound to the posterior wall of the trunk                                  3

• Isolated injury to the spinal cord
Spinal cord injury of the cervical spine without vertebral lesion         1
Spinal cord injury of the thoracic spine without vertebral lesion         1
Spinal cord injury of the lumbar spine without vertebral lesion           1
Spinal cord injury to the sacral spine without vertebral lesion           1
Cauda equina injury without vertebral lesion                              1

• Damage to the roots and rachidian plexus
Damage to one or more cervical roots                                      1
Damage to one or more thoracic roots                                      1
Damage to one or more lumbar roots                                        1
Damage to one or more sacral roots                                        1

• Other impairments of the spine
Herniated cervical disc                                                   2
Herniated thoracic, lumbar or lumbosacral disc                            2
Acquired spondylolisthesis                                                2

Region 4: Pelvis, abdomen and pelvic structures

• Amputations
Amputation of the penis                                                   2
Amputation of the testicles, including rupture                            2

• Complications
Premature delivery or miscarriage                                         1
Pregnancy complications                                                   1
Laparatomy                                                                2

• Contusions where skin is not broken
Wound of the abdominal wall                                               3
Wound of genital organs                                                   3

• Foreign bodies
Foreign body in the digestive apparatus                                   3

• Sprains
Thoracic or thoracolumbar sprain                                  See spinal column
Sacroiliac sprain                                                         2
Pelvic sprain (pubic symphysis)                                           2

• Fractures
Fractue of the pubis                                                      2
Fracture of the ilium and/or ischium                                      2
Multiple fractures of the pelvis                                          2

• Dislocations
Dislocation in the pelvis                                                 2

• Wounds
Wound of the front or side abdominal wall                                 3
Wound of the external genital organs                                      3
Wound of the perineum                                                     3
Vaginal wound                                                             3

• Injury to internal organs of the abdomen and pelvis
Damage to the stomach                                              See laparatomy
Damage to the small intestine                                      See laparatomy
Damage to the large intestine and/or rectum                        See laparatomy
Damage to the pancreas                                             See laparatomy
Damage to the liver                                                See laparatomy
Damage to the spleen                                               See laparatomy
Damage to the kidney                                               See laparatomy
Damage to the bladder and/or the urethra                           See laparatomy
Damage to the urethra                                              See laparatomy
Damage to internal genital organs                                  See laparatomy
Damage to other intra-abdominal organs (gall bladder, 
cystic ducts, peritoneum, adrenal gland)                                  3

• Abdominal wall, inguinal or femoral trauma
Inguinal or femoral hernia                                         See laparatomy
Epigastric or umbilical hernia                                     See laparatomy

• Blood vessel damage
Damage to the abdominal aorta                                      See laparatomy
Damage to the inferior vena cava                                   See laparatomy
Damage to the celiac trunk and/or mesenteric arteries              See laparatomy
Damage to the portal vein and/or spenic vein                       See laparatomy
Damage to renal blood vessels                                      See laparatomy
Damage to iliac blood vessels                                      See laparatomy

Region 5: Head, neck, face

• Impairment of the eye and of its adjacent structures
Eyelid tear with impairment of the lacrimal ducts                         3
Eyelid or periocular tear without impairment
of the lacrimal ducts                                                     3
Choroidal or retinal detachment                                           2
Traumatic enucleation                                                     2
Hemorrhage of the iris or ciliary body                                    2
Vitreous hemorrhage                                                       2
Hemorrhage and rupture of the choroid                                     2
Retinal or preretinal hemorrhage                                          2
Subconjunctival hemorrhage                                                3
Perforation of the eyeball                                                2
Trauma to the eyeball                                                     2
Orbital wound                                                             2

• Burns
Burns to the cornea or conjunctival sac                                   2
First-degree burn to the head or neck                                     3
Second-degree burn to the head or neck                                    1
Deep second-degree burn to the head or neck                               1
Third-degree burn to the head or neck                                     1
Burn to the mucous membrane of the mouth and pharynx                      3
Internal burn to the larynx, trachea or lung                       See burns to the
                                                                     head or neck
Unspecified burn to the eye and its adjacent structures            See burns to the
                                                                     head or neck
Burn to the eyelid and/or periocular region                        See burns to the
                                                                     head or neck

• Complications
Stroke                                                                    1
Cerebral embolism                                                         1

• Contusions
Contusion of the face, scalp and/or neck                                  3
Contusion of the eyelid and/or the periocular region                      3
Contusion of orbital tissue                                               2
Contusion of the eyeball                                                  2

• Foreign bodies
Foreign body in the mouth                                                 3
Foreign body in the cornea                                                3
Foreign body in the ear                                                   3
Foreign body in the conjunctival sac                                      3

• Sprains
Sprain (displacement) of the nasal septum cartilage                       3
Maxillary sprain                                                          3

• Fractures
One or more broken teeth                                                  3
Fracture of bones of the nose                                             3
Mandible fracture                                                         3
Fracture of the malar bone and/or maxilla                                 3
LeFort I-type fracture                                                    3
LeFort II-type fracture                                                   2
LeFort III-type fracture                                                  2
Fracture of the orbital floor or lower orbital wall                       1
Fracture of the larynx and/or trachea                                     1
Fracture of the palace and/or tooth sockets                               3
Fracture of the orbit (excluding fractures
of the upper wall or orbital floor)                                       3
Fracture of base without intracranial trauma                              1
Fracture of base with intracranial trauma                                 1
Fracture of calvarium without intracranial trauma                         1
Fracture of calvarium with intracranial trauma                            1

• Dislocations
Temporo-maxillary dislocation                                             3

• Wounds
Facial wound                                                              3
Thyroid gland wound                                              See related wounds
Head wound, excluding face                                                3
Outer ear injury                                                          3
Injury of the internal parts of the mouth, including the tongue           3
Neck wound                                                                3
Laryngeal and/or tracheal wound                                  See related wounds
Pharyngeal wound                                                 See related wounds
Wound of the tympanum and/or eustachian tube                     See related wounds

• Intracranial trauma not associated with a skull fracture
Concussion
Mild craniocerebral trauma (loss of
consciousness for less than 30 minutes
and/or Glasgow Coma score of 13 or
more and/or post-traumatic amnesia for less than 24 hours)                3
Moderate or severe craniocerebral trauma                                  1
Cerebral contusion or laceration                                          1
Intracranial hemorrhage                                                   1
Subarachnoid hemorrhage, extradural or subdural hematoma                  1
Trauma to the labyrinth                                                   1

• Superficial trauma
Superficial trauma of the conjunctiva                                     3
Superficial trauma of the cornea                                          3
Superficial injury to the face, neck and/or scalp                         3
Damage to superficial nerves of head and/or neck                          3

• Cranial nerve damage
Damage to the common motor ocular nerves                                  1
Damage to the abducens nerve                                              1
Damage to the optic nerve and/or visual pathways                          2
Damage to the trochlear (pathetic) nerve                                  1    

O.C. 1925-89, Sch. I; O.C. 789-93, s. 13; O.C. 1332-99, s. 7.