Accident Evaluation compensation Quality automobile INSURANCE of life NON-PECUNIARY DAMAGE Compensation for a Diminished Quality of Life Applicable for accidents that have occurred since January 1, 2000
1 Compensation for a Diminished Quality oflife1 This booklet explains the assessment process and calculation methods used to arrive at a compensation decision in your case. We suggest that you consult it and keep it. 1. In accordance with the Automobile Insurance Act, compensation for a diminished quality of life corresponds to non-pecuniary damage (damage that is not financial). This booklet was designed to help you understand the related legal texts. The Act and the Regulation respecting lump-sum compensation for non-pecuniary damage are the legal references.
2 Table of Contents Compensation for a diminished quality of life................................ 3 What is it?... 3 Do you qualify for compensation for a diminished quality of life?... 3 How is the extent of your diminished quality of life determined?... 4 Criterion for assessing diminished quality of life... 4 What happens if I do not have any permanent impairment or if my impairment is below the threshold of entitlement to compensation?... 5 Example if you have permanent impairments... 5 Example if you do not have permanent impairments............................................. 5 Frequently asked questions... 12 Why does the text for the severity category assigned to me not correspond exactly to my situation?... 12 describe problems I don t have?... 12 not describe all of my problems?... 12 Does the assessment take into account my lifestyle and habits?... 13 the fact that I am right-handed, left-handed or ambidextrous?... 13 the fact that I have a bilateral impairment?... 14 the fact that I already had an impairment before the accident?... 14 the possibility that my condition may deteriorate in the future?... 14 my financial losses, if I am unable to work?... 15 What happens in the event of death?... 16
3 Compensation for a diminished quality of life What is it? The injuries that you sustained in your automobile accident may have caused pain, mental suffering (loss of self-esteem, sadness, etc.) or difficulties performing certain daily activities (household tasks, recreational activities, etc.), thus affecting your quality of life. Compensation for a diminished quality of life is designed to recognize this reality. There is no medium of exchange for happiness. There is no market for expectation of life. Money will never relieve you of the pain, mental suffering or loss of enjoyment of life which you have had to face or still have to face 1. Thus, this compensation, or indemnity as it is also known, is not a reimbursement. Rather, it is a way of recognizing that your quality of life has been affected. To a certain extent, it provides you with the means whereby life can be made more bearable. This indemnity is awarded in addition to any other amounts you may be paid to compensate for financial losses, such as: Earnings loss: Income replacement indemnity; Indemnity for loss of employment; Lump sum to compensate for late arrival on the job market because of a lost school year or term. Accident-related expenses: Reimbursement of certain expenses stemming from the accident (eg. medical or paramedical care, medication, personal assistance, care expenses, rehabilitation). Do you qualify for compensation for a diminished quality of life? You may be entitled to this indemnity if you were injured in an automobile accident and sustained physical damage or mental problems. However, as is generally the case in the insurance field, compensation applies after a certain level or threshold. The expression, below the threshold of entitlement to compensation does not imply having no problems. It simply means that, according to compensation rules, the severity of your injuries is below the level that qualifies for an indemnity. 1. Justice Brian Dickson (Supreme Court decision in Andrews v. Grand Toy Alberta Ltd., [1978] 2 SCR. 261)
4 How is the extent of your diminished quality of life determined? Ideally, we would be able to precisely measure a person s pain, mental suffering and difficulty in performing everyday tasks. However, this is very difficult due to the subjective nature of these kinds of problems. All individuals are unique, and have their own lifestyles, tastes, talents, etc. For this reason, even though injuries are identified and impairments assessed objectively and individually for each accident victim, we apply standard criteria, using scales and grids, to determine the amount of compensation for a diminished quality of life. Compensation amounts are calculated in accordance with the rules provided by the Act and Regulation. These compensation assessment steps are based on the medical information in your file at the Société de l assurance automobile du Québec (SAAQ) and, if necessary, on the opinion provided by an independent expert at the SAAQ s request. Criterion for assessing diminished quality of life The compensation amount for the diminished quality of life that you have suffered because of your accident, from the time of the accident and for the rest of your life, is calculated on the basis of the severity of your permanent functional impairments and damage to your appearance. Examples : Functional impairment: A decrease in the body s ability to carry out certain functions, for instance a deterioration in vision, difficulty getting around, digestive problems, limited manual dexterity, etc. Esthetic impairment: Persistence of obvious scars or deformities For every bodily function, the scale referred to as the Schedule of Permanent Functional and Esthetic Impairments has a section with different categories of severity. For each category, there is a percentage representing the significance of the impact of this impairment on quality of life. These percentages were determined taking into account what it would mean to most Quebecers to have to live with those impairments.
5 What happens if I do not have any permanent impairment or if my impairment is below the threshold of entitlement to compensation? Some people are fortunate and their injuries improve, or perhaps heal entirely. Others are left with minor impairment below the threshold of entitlement to compensation. However, we need to recognize that the quality of life of these people was diminished for a certain amount of time. In cases such as these, the amount of the indemnity for a diminished quality of life as a result of the accident is determined on the basis of severity of the injuries sustained in the accident. A second scale called the Schedule of Injuries gives a severity rating from 1 to 6 for all possible traffic accident injuries. This rating represents the impact an injury has on quality of life. Each rating is determined by taking into account what it would mean to most Quebecers to have sustained this injury. There are special methods for calculating compensation in a case involving more than one impairment or injury. These methods, which are described in the examples below, make it possible to assess and take into consideration the combined effect of the impairments or injuries depending on the situation. The calculation methods are described in the two examples below. 1 2 Ms. Blair s Case This example illustrates the situation of a person who has permanent impairment. Ms. Blair sustained the following injuries in her automobile accident: head: a moderate traumatic brain injury; face: a wound on her forehead; right leg: an open leg fracture. Mr. Morrison s Case This example illustrates the situation of a person who was not left with any permanent impairment or who was left with after-effects below the threshold of entitlement. Mr. Morrison sustained the following injuries in his automobile accident: face: fractured nose; right arm: arm fracture and sprained wrist; left leg: knee sprain; thorax: a fractured rib.
6 How these cases progressed 1 Ms. Blair 2 STEPS 1 Assessment of the accident victim s condition 2 Identification of after-effects EXPLANATIONS Once the person s condition has stabilized, the SAAQ studies the medical information in the file to see whether there is any permanent impairment. Sometimes the opinion of a specialist, who acts as an independent expert, is required to identify and describe permanent impairment. After examining the accident victim and consulting the medical file, the specialist submits a report to the SAAQ. The body is divided according to ability to perform its main functions. Damage to appearence (esthetic) is also taken into account. Examples of functions: vision, hearing, locomotion, dexterity, digestion, mental function. After maximum recovery following treatment, Ms. Blair was left with mental problems and difficulty walking. She also has a scar on her face and another one on her right leg. Ms. Blair s case requires assessments by specialists. Each specialist studied the case file, questioned and examined Ms. Blair, then submitted a report to the SAAQ. According to the specialists, Ms. Blair s mental function and locomotion are affected, as are the appearance of her face and right leg. Mr. Morrison Mr. Morrison s injuries progressed favourably. According to the medical information on file, he does not have any permanent impairment in his limbs or thorax. However, there is not enough information on file to rule on whether there is impairment concerning his nose fracture. Therefore, Mr. Morrison was examined by a specialist to assess the impact of the fracture. The specialist studied the file, questioned and assessed Mr. Morrison, then sent the report to the SAAQ. According to the specialist, Mr. Morrison does not have any after-effects from his fractured nose. All of the injuries are deemed to have healed well and there are no impairments.
How these cases progressed (cont d) 1 Ms. Blair 2 STEPS 3 Determination of indemnity for a diminished quality of life EXPLANATIONS The amount of compensation for a diminished quality of life that a person has suffered because of an accident, from the time of the accident and for the rest of his or her life, is calculated on the basis of the severity of permanent functional impairments and damage to appearance. If the injuries heal well and there is no impairment, or only minor after-effects that are below the threshold of entitlement to compensation for permanent impairment, the indemnity is calculated on the basis of the severity of injuries sustained in the accident. In Ms. Blair s case, the indemnity for a diminished quality of life is based on the extent of her permanent impairments. Mr. Morrison 7 In Mr. Morrison s case, since there is no permanent impairment, the indemnity for a diminished quality of life is based on the severity of injuries he sustained. An analysis of the file shows that Mr. Morrison sustained 5 injuries: 1. Nose fracture 2. Right arm fracture 3. Right wrist sprain 4. Left knee sprain 5. Rib fracture Starting from step 4, the two sample cases will be assessed differently (pages 8 and 9 for Ms. Blair and pages 10 and 11 for Mr. Morrison).
8 1 Ms. Blair s Case Steps involved in cases where a person has permanent impairment STEPS EXPLANATIONS RESULTS 4 Estimating severity of impairment Scale Category of severity Percentage The scale referred to as the Schedule of Permanent Functional and Esthetic Impairments describes the categories of severity provided for each function. Each category of severity describes one or more situations stemming from permanent impairment. For example, for locomotion, there are 7 categories of severity: Slight stiffness that does not have much effect on walking would be rated as being in severity category 1. Inability to move from one place to another without a wheelchair is rated as being in severity category 7. In their reports, the specialists consulted specify the category of severity rated for each function affected, corresponding to the situation with the greatest impact. Each of the categories of severity corresponds to a percentage that represents the significance of the impact of the impairment on quality of life. According to specialists, Ms. Blair s condition is as follows: Mental function: Attention and memory problems, which correspond to severity 3 for this function. Esthetic of the face: 1.5 cm reddish scar on forehead, which corresponds to severity 1 for that part of the body. Locomotion: A limp and problems walking quickly, which correspond to severity 2 for that function. Esthetic of the right leg: 12 cm linear scar, which corresponds to severity 2 for that area of the body. In Ms. Blair s case: Mental function: Severity 3 15 % Esthetic of the face: Severity 1 1% Locomotion: Severity 2 6% Appearance of the right leg: Severity 2 1%
1 Ms. Blair s Case STEPS EXPLANATIONS RESULTS 5 Calculation of the combined effect of several impairments 6 Calculation of the amount of the indemnity Since each percentage was created as if the impairment in question was the only one, we have to use a calculation method to assess their combined impact. The optimum quality of life for a person is rated at 100%. We carry out the calculation as per the provisions of the Act and the Regulation. For a decision regarding impairment rendered during the year 2000, the amount corresponding to 1% is $1,750. It is indexed each year to take inflation into account. Examples for 2000 Final Indemnity assessment amount 1% $1,750 10% $17,500 100% $175,000 In Ms. Blair s case: 1. We apply the highest percentage: 15%. 100% 15% = 85% 2. We apply the second highest percentage: 6%. 6% of 85% = 5.1% 85% 5.1% = 79.9% 3. We apply the third highest percentage: 1%. 1% of 79.9% = 0.8% 79.9 % 0.8% = 79.1% 4. We apply the fourth highest percentage: 1%. 1% of 79.1% = 0.79% 79.1% 0.79% = 78.31% With a maximum of 100%, there is 78.31% left. Therefore, Ms. Blair is deemed to have sustained a diminished quality of life corresponding to a percentage of: 100% 78.31% = 21.69%. The final result is rounded up, in this case to 22%. The amount that Ms. Blair will be paid for a diminished quality of life is: 22 x $1,750 = $38,500 9
10 2 Mr. Morrison s Case Steps involved in cases where a person has no permanent impairment or whose after-effects are below the threshold of entitlement to compensation STEPS EXPLANATIONS RESULTS 4 Estimating severity of injuries Scale Severity rating 5 Calculation of the combined effect of several impairments The Schedule of Injuries gives a severity rating from 1 to 6 for all injuries that could be sustained in traffic accidents. This rating represents the significance of the impact of an injury on quality of life. Since the provision for each severity rating was given as if the injury in question was the only one, if there is more than one injury, we need to use a calculation method to evaluate their combined effect. All calculations are performed in compliance with the rules set out in the Act and the Regulation. The method takes both the severity of the injuries and the parts of the body affected into account. For the purposes of this calculation, the body has been divided into 12 parts, for example, face, thorax, limbs, mental function, etc. According to the Schedule of Injuries the severity ratings in Mr. Morrison s case are: Nose fracture 3 Right arm fracture 4 Right wrist sprain 3 Left knee sprain 3 Rib fracture 3 Mr. Morrison sustained injuries in 4 areas: 1. Face 2. Right arm 3. Left leg 4. Thorax
Mr. Morrison s Case STEPS EXPLANATIONS RESULTS 5 (cont d) Severity rating 2 6 Calculation of the amount of the indemnity We calculate the indemnity according to the following rules: 1. For each part of the body affected, we decide which injury has the highest severity rating. 2. We then add the highest rating for each part of the body, after squaring them. Under the Regulation, a maximum of 3 ratings may be added this way. 3. We then use the total amount calculated to determine the category of severity using the chart below. 1 to 8 = category a 9 to 15 = category b 16 to 24 = category c 25 to 35 = category d 36 and higher = category e There is an amount of compensation for each severity category. This amount is indexed annually to take inflation into account. Examples for the year 2000 1 to 8 = category a = $ 0* 9 to 15 = category b = $ 300 16 to 24 = category c = $ 500 25 to 35 = category d = $ 800 36 and higher = category e = $ 1000 * Severity category b is the minimum required to qualify for an indemnity. 11 The following are the injuries with the highest rating for each part of the body: 1. Face: nose fracture, rating of 3. 2. Right arm: arm fracture, rating of 4. (The wrist sprain is not counted because it is in the same part of the body as the right arm fracture, which has a higher severity rating.) 3. Left leg: knee sprain, rating of 3. 4. Thorax : rib fracture, rating of 3. Calculation: 4 2 + 3 2 + 3 2 = 34 16 + 9 + 9 = 34 Therefore: The total of 34 puts Mr. Morrison in severity category d. The amount that will be paid to Mr. Morrison for a diminished quality of life is $ 800, the amount provided for in category d.
12 Frequently asked questions 1 Why does the text for the severity category assigned to me...not correspond exactly to my situation?...describe problems I don t have?...not describe all of my problems? It would be almost impossible to describe all of the different forms of permanent functional and esthetic impairment that automobile accident victims might have. Our solution was to group together all of the permanent impairments that could affect each key bodily function in categories of severity. However, we only used a few sample situations that might arise from permanent impairments to describe each category. The assessment procedure is quite simple. Once impairments have been objectively assessed, the impairments are compared with the situations described under the severity categories. The category used is the one with descriptions that best correspond to the conclusions of the objective examination findings. Of course, for an impairment to correspond to a particular category of severity, the findings of the examination do not have to include all of the situations described in that category. Likewise, choosing one category of severity does not mean that everything coming under that category applies to that particular person. Example : As a result of a shoulder injury, a person was left with a functional limitation of approximately 25% for the ability to extend the arm sideways (shoulder abduction). Under the Regulation, this impairment corresponds to a severity rating of 2. Although this exact situation is not described under severity category 2, two others are: 1. Decrease of 25% in the amplitude of shoulder anterior elevation combined to a similar decrease of shoulder internal rotation. 2. Decrease of 25% in the amplitude of elbow extension. Severity category 2 has therefore been chosen because of the impact of the objective after-effects found during examination is comparable, according to the Regulation, to the impact of the impairment in the example.
2 Does the assessment take into account 3...my lifestyle and habits? 13 Does the assessment take into account...the fact that I am right-handed, left-handed or ambidextrous? NO Ideally, we would be able to precisely measure an individual s diminished quality of life exactly, in keeping with lifestyle. However, this is very difficult due to the subjective nature of a person s pain, mental suffering and difficulty in performing certain tasks. People are all unique, with their own individual tastes, talents, skills, etc. Therefore, we use the same criteria for everyone in our compensation system, so that we can efficiently and fairly assess thousands of accident victims. This means that two people with the same impairments will receive the same amount of compensation for a diminished quality of life, although one may be athletic while the other is more sedentary. YES This is taken into consideration with functional impairment of the arms. The impact of a functional impairment of an arm is particularly great when the dominant arm is the one affected. Although a person can adjust to a certain extent over the years, impairments of a dominant arm have greater repercussions. This is why the categories of severity provide for a greater percentage in these cases. What happens if I am ambidextrous? For compensation purposes, the arm used predominantly in routine daily tasks and activities is considered to be dominant.
4 14 Does the assessment take into account...the fact that I have a bilateral impairment? (affecting both arms for instance)? 5 Does the assessment take into account...the fact that I already had an impairment before the accident? YES A bilateral impairment means functional after-effects in both arms or legs, or in two symmetrical organs (eg. both eyes or ears). Depending on the functions affected, consequences for the accident victim may be greater than the simple addition of impairment to each side, a reality taken into consideration in the Regulation. If there is bilateral impairment to the arms, a mathematical formula is used that takes all impairments into account to determine the extent of additional severity. For legs, the functional impact resulting from bilateral impairment is automatically taken into consideration in the overall assessment of locomotion, because this assessment reflects the combined and complementary role played by the legs. Overall assessment methods also take the greater functional impact into account in the case of other functions affected by a bilateral impairment - vision or hearing for instance. YES Each bodily function is evaluated separately. A person whose quality of life was diminished by an impairment affecting a certain function before the accident is entitled to an indemnity if the condition has deteriorated as a result of the accident. To be eligible for the indemnity, however, the deterioration must be significant enough for the person s condition to correspond to a severity category which is higher than the one before the accident. 6 Does the assessment take into account...the possibility that my condition may deteriorate in the future? YES The final assessment, which determines the total amount of compensation, i.e. the indemnity, is usually completed once all injuries have healed or stabilized. Sometimes, a person s condition can deteriorate over time. Accident victims files remain open at the SAAQ for the person s lifetime. If someone s condition deteriorates, we reassess the case. When the deterioration is significant enough for the severity category to change, the combined effect of all impairments is recalculated and the amount of compensation is adjusted accordingly.
15 Example: Five years after the impairment assessment, a person considers that her condition has deteriorated. She sends the SAAQ a report from her physician explaining everything. The case will be reviewed and, if necessary, a new assessment will be conducted by an expert physician. If the assessment findings confirm that her condition has deteriorated to the point where a new category of severity is determined, we recalculate the indemnity, taking this new severity category into account; the amount of the indemnity for a diminished quality of life is then adjusted in keeping with the amount already awarded. 7 Does the assessment take into account...my financial losses, if I am unable to work? NO There are other indemnities specifically designed to compensate for a person s financial losses if they can no longer work. The indemnity for a diminished quality of life is basically designed to recognize all the negative consequences that accident victims suffer in their everyday life (in particular, loss of enjoyment of life, mental suffering and pain), but not any loss of income because they are no longer able to work. In fact, people who have been left with permanent after-effects are often still able to work. As mentioned above, the impact on everyday life is calculated on the basis of a standard scale that applies to any Quebecer who has to cope with these after-effects or who has sustained these injuries. In the case of people who have been left with permanent impairments, the indemnity for a diminished quality of life is the same for everyone, regardless of status, occupation, habits or recreational activities. Example: Let s compare a professional pianist with a person who enjoys playing piano in his spare time, but whose work does not require manual dexterity. For the purpose of this example, we will assume that both lose the same finger in an accident. DIMINISHED QUALITY OF LIFE Person who plays piano in his spare time Person who earns a living from playing the piano This person will receive an indemnity for a diminished quality of life, just like anyone else who has to cope with this impairment on a daily basis. This person will be entitled to the same indemnity for a diminished quality of life. In addition, if he can no longer play professionally, the loss of income will be assessed and compensated separately.
16 8 What happens in the event of death? The diminished quality of life experienced by an accident victim prior to death can qualify for compensation. This indemnity is awarded regardless of whether the person died as a result of the accident or from other causes. If the person dies less than 24 hours after the accident, no indemnity for a diminished quality of life is awarded. If the person dies more than 24 hours - but less than 1 year - after the accident, we calculate the amount of the indemnity for a diminished quality of life on the basis of the severity of the injuries sustained in the accident. If the person dies more than a year after the accident, there are two possible scenarios: If permanent impairments were expected, we calculate the indemnity on the basis of the severity of the functional or esthetic impairment that the person would probably have been left with. If no permanent impairments were expected, we calculate the indemnity on the basis of the severity of the injuries sustained in the accident.
For more information, call one of the following numbers: Toll Free Anywhere in Québec 1 800 463-6890 Outside Québec (in Canada and the USA) 1 800 463-6898 You will be put in touch with your compensation officer when necessary. Accident evaluation compensation Quality of life C-5111-A (12-01)