SPINAL CORD injuries: How to fund your care and understand the legal labyrinth Andrew C. Murray, LERNERS LLP

OVERVIEW Injury – Funding and Compensation Lawsuits Motor Vehicle Accidents Collateral Benefits Non-Motor Vehicle Accidents Workplace Lawsuits Claims to be Advanced Claims Barred Current Motor Vehicle Accident Benefits (“SABS”) Catastrophic Injuries

Funding and compensation INJURY MVA COLLATERAL BENEFITS NON-MVA WORKPLACE

Funding and compensation MVA sabs - IRBs and Non-Earner Benefits - Caregiver Benefits (CAT) - Attendant Care (CAT) - Housekeeping (CAT) - Medical/Rehab tort - Legally funded reports (tort reports) i.e. Life Care Plans - General damages (pain and suffering) - Special damages (out-of-pocket expenses) - Past and future economic losses - Family law act/dependant damages claims

Funding and compensation COLLATERAL BENEFITS - GROUP OR PRIVATE BENEFITS (i.e. through employer) - CRITICAL INJURY INSURANCE - ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE - STD/LTD - EXTENDED HEALTH CARE BENEFITS - CPP Disability - Ontario Works (OW) or Ontario Disability Support Program (ODSP) - ASSISTIVE DEVICES PROGRAM - CICB - MORTGAGE INSURANCE

Funding and compensation NON-MVA Tort claim only -- Ohip funded treatment - Legally funded reports (tort reports) i.e. life care plans - General Damages (pain and suffering) - Special damages (out-of-pocket expenses) - Past and future economic losses - Family law act/dependant damages claims

Funding and compensation WORKPLACE WSIB

lawsuits Claim to be Advanced MVA - multi-vehicle accidents, where another party is at fault; MVA – where a pedestrian, cyclist, etc. is struck by a vehicle; MVA – single vehicle where the County or Municipality failed to maintain a roadway; Personal Injury – where another party is at fault or negligent (i.e. slip and falls, assault, injuries sustained at amusement parks, etc.) Claim Barred MVA – single vehicle accidents where no other party or entity is at fault/negligent; MVA – multi-vehicle accidents where both parties are in the course of their employment at the time of the accident and considered to be Schedule 1 Employees pursuant to the WSIB; Slip and fall, or any type of injury, where there is no negligence on the part of the other party.

Statutory accident benefits (“SABS”) The Statutory Accident Benefits Schedule – effective September 1, 2010 is a schedule to the Insurance Act that allows injured persons to claim for benefits to compensate for losses that an individual may incur as a result of a motor vehicle accident. The claim for benefits is to be made to the injured person’s own motor vehicle insurer. If the injured person does not have their own motor vehicle insurance coverage, then there are provisions that allow for the accident benefit claim to be advanced against other insurers, such as the issuer of an insurance policy on which the injured person is a listed driver, the insurer of a company vehicle that has been supplied to the injured person for regular use; the insurer of the vehicle in which the injured person was a passenger; or the insurer for any motor vehicle involved in the accident. This determination of proper responding insurer is called “Priority”. The key benefits in the Statutory Accident Benefits Schedule are income replacement benefits, attendant care benefits, and medical and rehabilitation benefits.

Statutory accident benefits (“SABS”) – Con’t The monetary limits of the benefits payable and the duration of entitlement are dramatically impacted by whether the impairments sustained by the injured person are characterized as a catastrophic (“CAT”) impairment, non-catastrophic impairment or as falling within the Minor Injury Guideline (“MIG”).

CATASTROPHIC INJURY Catastrophic impairment is defined within the SABS (for accidents occurring on or after September 1, 2010) as: paraplegia or tetraplegia Based on ASIA Impairment Scale Not CAT if incomplete spinal cord injury Unless at least half of key muscles below the neurological level have a muscle grade greater than 3 AND spinal cord independence measure for mobility indoors is 0 to 5 (If you walk without aids, or only need leg orthosis, or need one cane only, you aren’t CAT.)

Criminal Injuries Compensation Board MVA NON-MVA SABS Tort claim CPP disability OW ODSP LTD Critical injury policy ADP Mortgage insurance Collateral benefits WSIB CRIMINAL ACTS Criminal Injuries Compensation Board