Mental Impairment under Ontario’s SABS

Under Ontario’s Statutory Accident Benefits Schedule (SABS) an injury can fall into one of three categories: 1. a minor injury; 2. Non-minor injury; or 3. Catastrophic injury or impairment. The type of category your injury is placed in will impact the extent of your benefits under the SABS. Minor injuries, which are defined by the SABS, include cuts, bruises, strains, sprains. Catastrophic injuries, also defined by the SABS, include amputated limbs, spinal cord injuries, or serious brain damage. The Non-minor injury is the in-between category. Insurance companies tend to place most people in the minor injury category. Part of our job, as your advocates, is to ensure that you are placed in the right category, which very often should not be in the minor injury one.

This becomes even more complex when the injury described is a mental impairment because it is easier to categorize an injury when an injury has apparent physical manifestations. Recently, the case of Mujku v State Farm has shed some light on these sorts of injuries. In that particular case, the plaintiff, Mrs. Mujku, was involved in a minor accident; physically, she suffered soft tissue injuries. Gradually, however, Mrs. Mujku’s mental state suffered to the extent that she was diagnosed with a major depressive disorder and a psychological disorder associated with pain.

Arbitrator Jeffrey Rogers determined that Mrs. Mujku did suffer a catastrophic impairment within the meaning of section 2(1.2)(g) of the SABS. According to the American Medical Association’s Guides to the Evaluation of Permanent Impairment, anyone applying for catastrophic impairment under a mental disorder must have an impairment in one of four areas of functioning: 1) activities of daily living; 2) social functioning; 3) concentration, persistence and pace; or 4) deterioration or decompensation in work or work like settings. Arbitrator Rogers argued that, in Mrs. Mujku’s case, “psychological factors play a major role with respect to daily functioning, including a significant impact on exacerbating her pain conditions that further limit her[i],” and was therefore impaired under the fourth category.

For more information on the SABS and mental/behavioural impairments, contact Bergel, Magence, LLP at 416-665-2000 for a free consultation.