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Catastrophic Application/Rebuttal

Dr. Salmon's unique methodology to address evolving case law

Desbiens & Related Case Evolution: Directing... CAT Ratings

Review of Pain Disorder re. Evolving Case Law

CAT Panel Recommendations (2011) which under government consideration

CAT Team Director

Dr. Salmon leads a highly trained and experienced group of medical, psychological, occupational therapy and clinical support experts in performing multi-disciplinary CAT assessments for both OCF 19 support and CAT IE rebuttal purposes.

Dr. J. Douglas Salmon, Jr. has been providing Catastrophic determination assessments from the outset of the CAT entitlement process. He was the Chair of the original Minister of Finance's CAT DAC Mental/Behaviour Subcommittee and member of the Glasgow Outcome Scale Subcommittee, with activities including development of the original CAT clinical guidelines in these spheres and development and training of all CAT DAC OTs throughout the province. He was subsequently a consultant to the Minister's DAC Committee on specific CAT matters. He is a senior faculty member with the only university based AMA Guides/Catastrophic Impairment Certification & Training program in Ontario (CMCC/CSCE); in this capacity, he has trained hundreds of medical and allied health professionals in the brain injury, mental/behavioural and Desbiens CAT rating protocols. Dr. Salmon is on the Board of Directors for the Alliance for Community Medical and Rehabilitation and Co-chairs the organization's Standards & Guidelines Committee and is a member of a similar committee for the Canadian Association of Psychologists in Disability Assessment. He had previously been the Associate Canadian Vice President/Ontario Vice President, Association for Scientific Advancement in Psychological Injury and Law since its inception.

Dr. Salmon videos pertaining to Catastrophic Impairment assessments

Catastrophic Impairment Applications (OCF 19)

On the basis of a comprehensive file analysis, a detailed charting of the recognized diagnoses and impairments to date is prepared. The file analysis concludes with identifying 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. Typically 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 Sept/10 SABS, an OCF 19 Catastrophic Application is then submitted by a medical specialist or neuropsychologist depending upon the specific CAT criteria met. The CAT ratings always include consideration of the Desbiens case law of combining psychological and physical impairments and utilize Dr. Salmon's unique methodology to address evolving case law. Given that CAT rebuttals are no longer insurer funded, the OCF 18 based multi-disciplinary assessment is the best opportunity for comprehensive non-IE evaluation.

Catastrophic Impairment IE Review & Challenge

This service provides state of the art specialty medical, neuro/psychological and/or OT functional assessment towards addressing MVA Catastrophic Impairment entitlement. The process commences with a careful review of the CAT IE Report to identify clinical and/or methodological errors in the report 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
  • Incorrect diagnoses
  • Lack of empirical basis for conclusions (especially psychiatry whereby rarely are psycho-diagnostic or cognitive measures utilized to support opinion)
  • Inconsistencies between IE opinions within the IE multi-disciplinary report
  • Failure of diagnostic assessors to integrate functional findings of OTs
  • Failure to utilize best practices, state of the art methodology for OT In-Home Assessment to provide evidence base for the Mental/Behavioural ratings
  • Failure to utilize a Situational Work Assessment to provide evidence base for the Adaptation domain rating
  • Failure to provide a Desbiens rating at all
  • Failure to provide Desbiens rating that is consistent with that directed in the case law (e.g. the California method has not been supported)

Upon identifying the weaknesses of the CAT IE report, a cost-conscious staged approach is utilized to provide a report which challenges the IE assessment on the basis of evidence based assessment(s). The CAT ratings always include consideration of the Desbiens case law of combining psychological and physical impairments and utilize Dr. Salmon's unique methodology to address evolving case law. 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. Additionally, when indicated specialty medical investigations (e.g. EMG, specialized radiological investigations) may be utilized to assure maximal rating considerations.






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