At HAL Disability Management Inc. a highly trained and experienced group of medical specialists and clinical support experts perform multi-disciplinary Catastrophic( CAT) Assessments for both OCF-19 support and Catastrophic Insurance Examination (IE) rebuttal purposes.

Catastrophic Impairment Applications (OCF 19)

Based on a comprehensive file analysis, detailed charting of the recognized diagnoses and impairments to date is prepared. The file analysis concludes with first giving a projection of the relevant CAT criteria and what findings can reasonably be expected. It further identifies the specific expert team of medical/mental health practitioners and clinical support staff required to address each of the noted diagnoses/impairments that will be considered for the Catastrophic Impairment Analysis. Projections are provided as to the probability of a team of assessors finding the client meets CAT threshold. Projections for each relevant CAT Criterion are provided as “Not Probable”, “Possible” and “Probable”.

Assessment protocols are delivered in a staged cost-effective manner. An OCF-18 for multi-disciplinary CAT determination assessment is then submitted along with the supporting file analysis report. In accordance with the September 2016 SABS, an OCF-19 Catastrophic Application is then submitted by a medical specialist or, in some cases, a neuropsychologist depending upon the specific CAT criteria met. The CAT Whole Person Impairment (WPI) ratings always include consideration of the Desbiens case law of combining psychological and physical impairments for accidents prior to June 2016 and the new criterion for accidents after June 2016 and utilize HAL’s unique methodology to address evolving case law. CAT rebuttals may be partially insurer funded depending on what Plaintiff assessments have already been done. In some cases, a single assessment for purposes of generating an OCF-19 Catastrophic Application can be done.

Catastrophic Impairment IE Review & Challenge

This service provides state of the art specialty medical, neuro/psychological and/or Occupational Therapy Situational towards addressing motor vehicle accident Catastrophic Impairment entitlement. The process commences with a careful review of the CAT IE Report to identify clinical and/or methodological errors including but not limited to the following issues:

  • Improper or insufficient assessors
  • Impairments which were omitted from the total rating
  • Inappropriate rating methodologies and protocols
  • Inappropriate application of the AMA Guides
  • Inconsistencies between IE opinions within the IE multi-disciplinary report
  • Failure of diagnostic assessors to integrate functional findings of the occupational therapy report with respect to Criterion 8 (post June 2016) or combined Criterion 7 (pre-June 2016)
  • Failure to utilize a Situational Work Assessment to provide evidence base for the Adaptation domain rating
  • Failure to conduct collaborative interviews with family members, friends, etc.

After identifying the weaknesses of the CAT IE report, a cost-conscious staged approach is utilized to provide a report which challenges the IE assessment based on evidence-based assessment(s). Moreover, highly rigorous objective testing is employed to measure actual shortfalls in independent functioning (including parental responsibilities and daily financial independence) relative to the requirements of the Glasgow Outcome Scale (Extended).