Permanent Impairment Regulation

B.C. Reg. 61/2021
O.C. 113/2021

Deposited March 5, 2021
effective May 1, 2021

This consolidation is current to March 18, 2025.

Link to consolidated regulation (PDF)

Link to Point in Time

Insurance (Vehicle) Act

Permanent Impairment Regulation

[Last amended May 1, 2021 by B.C. Reg. 117/2021]

Contents
	1	Definitions for Act and regulation
	2	Meaning of "catastrophic injury"
	3	Compensation for permanent impairment
	4	Calculation of permanent impairment rating
	5	Calculation of permanent impairment component
	6	Enhancement component for symmetrical body parts
	7	Exceptions to section 6
	8	Permanent impairment compensation calculation — catastrophic injury
	9	Permanent impairment compensation calculation — non-catastrophic injury
	10	Compensation determined at time of accident
Schedule

Definitions for Act and regulation

1 (1) For the purposes of section 113 of the Act and in this regulation, "catastrophic injury" means a catastrophic injury within the meaning of section 2 of this regulation.

(2) In this regulation:

"Act" means the Insurance (Vehicle) Act;

"enhancement component" means the component of a permanent impairment rating that is

(a) calculated and determined in accordance with section 6 [enhancement component for symmetrical body parts], and

(b) expressed as a percentage;

"permanent impairment component" means the component of a permanent impairment rating that is

(a) calculated and determined in accordance with section 5 [calculation of permanent impairment component], and

(b) expressed as a percentage;

"permanent impairment rating" means the sum of the enhancement component and the permanent impairment component that is

(a) calculated and determined in accordance with section 4 [calculation of permanent impairment rating], and

(b) expressed as a percentage.

Meaning of "catastrophic injury"

2 (1) In this section, if a provision refers to an injury resulting in a percentage, the percentage is calculated and determined

(a) by applying section 4 [calculation of permanent impairment rating] as if the percentage to be calculated and determined were the permanent impairment rating,

(b) excluding all injuries resulting from the accident except those injuries listed in the applicable provision of this section, and

(2) For the purposes of section 1 (1), an insured sustains a catastrophic injury if the insured sustains any of the following:

(a) quadriplegia or paraplegia that meets the criteria for classification as Grade A or B on the ASIA impairment scale and is determined to result in a percentage, using the method described in subsection (1), of 65% or more;

(b) two or more of the following amputations:

(i) forequarter amputation of a shoulder and arm;

(ii) shoulder disarticulation;

(iii) above-elbow amputation of an arm, involving the proximal third of the humerus;

(iv) above-elbow amputation of an arm, involving the middle or distal third of the humerus;

(v) hemipelvectomy;

(vi) hip disarticulation, involving the proximal 1/3 of the femur;

(vii) proximal, mid-thigh or distal above-knee amputation of a leg;

(c) loss of vision that is determined to result in a percentage, using the method described in subsection (1), of 80% or more;

(d) a functional alteration of the brain of any of the following types or any combination of them that is determined to result in a percentage, using the method described in subsection (1), of 50% or more:

(i) a communication disorder that

(A) results in the insured's complete inability to understand and use language,

(B) does not affect the insured's ability to understand linguistic symbols, but severely impairs the insured's ability to use sufficient or appropriate language,

(C) does not affect the insured's ability to understand linguistic symbols, but moderately impairs the insured's ability to use sufficient or appropriate language, or

(D) results in minor communication difficulties;

(ii) an alteration of consciousness, including stupor, coma or another disorder or disturbance, and including adverse effects from medication, that prevents the person from performing the activities of daily living to such an extent that the insured requires continuous supervision in an institutional or controlled setting;

(iii) an alteration of consciousness, including stupor, coma or another disorder or disturbance, and including adverse effects of medication, that

(A) impairs the insured's ability to perform the activities of daily living to the extent that the insured requires periodic supervision in an institutional or controlled setting for 50% or more of the time,

(B) impairs the insured's ability to perform the activities of daily living to the extent that the insured requires periodic supervision in an institutional or controlled setting for less than 50% of the time,

(C) impairs the insured's ability to perform the activities of daily living to the extent that the insured requires supervision but not in an institutional or controlled setting, or

(D) impairs the insured's ability to perform the activities of daily living but not to the extent that the insured requires supervision;

(iv) an alteration of the higher cognitive or integrative mental functions, including adverse effects of medication, that

(A) prevents the insured from performing the activities of daily living to the extent that the insured requires continuous supervision in an institutional or controlled setting,

(C) impairs the insured's ability to perform the activities of daily living to the extent that the insured requires periodic supervision in an institutional or controlled setting for less than 50% of the time,

(D) impairs the insured's ability to perform the activities of daily living to the extent that the insured requires supervision but not in an institutional or controlled setting, or

(E) impairs the insured's ability to perform the activities of daily living but not to the extent that the insured requires supervision;

(e) a psychiatric condition, syndrome or phenomenon, including adverse effects of medication, that

(i) impairs the insured's ability to perform the activities of daily living, ability to function socially or sense of well-being, to the extent that the insured requires continuous supervision in an institutional or controlled setting, or periodic supervision in such a setting for 50% or more of the time, and

(ii) is determined to result in a percentage, using the method described in subsection (1), of 70% or more;

(f) full-thickness burns resulting in consequential impairments, excluding scarring or disfigurement to all surface areas of the body other than the face, that are determined to result in a percentage, using the method described in subsection (1), of 75% or more;

(g) a combination of any of the following injuries that is determined to result in a percentage, using the method described in subsection (1), of 80% or more:

(i) an amputation referred to in paragraph (b) of this subsection;

(ii) one or more of the following amputations:

(A) elbow disarticulation, including amputation of the proximal third of the forearm;

(B) below-elbow amputation, involving the middle third of the forearm;

(D) knee disarticulation, including proximal below-knee amputation, not suitable for a patellar tendon bearing prosthesis;

(E) below-knee amputation suitable for a patellar tendon bearing prosthesis;

(iii) quadriplegia or paraplegia that meets the criteria for classification as Grade C or D on the ASIA impairment scale with partial preservation of motor power, whether or not there is sensory preservation and whether the percentage under this subparagraph is the result of one or more permanent impairments;

(iv) loss of vision that is determined to result in a percentage, using the method described in subsection (1), of 50% or more but less than 80%;

(v) one or more of the following types of functional alteration of the brain that are determined to result in a percentage, using the method described in subsection (1), of 30% or more:

(A) inability to use both upper limbs for personal hygiene and self-care with evidence of both proximal and distal upper limb neurological dysfunction;

(B) inability to use one upper limb for personal hygiene and self-care with evidence of both proximal and distal upper limb neurological dysfunction;

(C) difficulty in using both upper limbs for personal hygiene and self-care with evidence of either proximal or distal upper limb neurological dysfunction bilaterally;

(D) difficulty in using one upper limb for personal hygiene and self-care with evidence of either proximal or distal upper limb neurological dysfunction;

(E) difficulty manipulating objects with impaired prehension confined to only one of the upper limbs, while still allowing independence in personal hygiene and self-care;

(F) difficulty manipulating objects with no impairment in prehension in either upper limb, while still allowing independence in personal hygiene and self-care;

(G) upper limb clumsiness, including tremor, dysmetria or dysdiadochokinesis, with impaired prehension confined to only one of the upper limbs, while still allowing independence in personal hygiene and self-care;

(H) upper limb clumsiness, including tremor, dysmetria or dysdiadochokinesis, with no impairment in prehension in either upper limb, while still allowing independence in personal hygiene and self-care;

(I) inability to stand or walk;

(J) ability to stand, but great difficulty or inability to walk;

(K) moderate difficulty in walking on irregular surfaces, stairways or uneven terrain;

(L) slight difficulty in walking;

(M) incontinence or urinary retention with complete loss of sphincter control;

(N) incontinence or urinary retention with partial loss of sphincter control;

(O) incontinence or urinary retention with dysfunction in the form of frequency or hesitancy;

(P) alteration of the bladder with or without enterocystoplasty;

(Q) a Class 1, 2 or 3 renal functional impairment;

(R) anorectal function with complete loss of control;

(S) anorectal function with limited control;

(T) a Class 1, 2 or 3 sexual dysfunction;

(U) one or more of the types of functional alteration of the brain referred to in paragraph (d) (i) (C) or (D), (d) (iii) (B) to (D) or (d) (iv) (C) to (E);

(vi) a peripheral nervous system injury involving all 3 trunks of the brachial plexus, with complete motor and sensory impairment, or a peripheral nervous system injury of one or more of the following types involving the brachial plexus:

(A) upper trunk, also known as Erb-Duchenne syndrome, with complete motor and sensory impairment;

(B) middle trunk, with complete motor and sensory impairment;

(vii) a psychiatric condition, syndrome or phenomenon, including adverse effects of medication, that

(A) impairs the insured's ability to perform the activities of daily living, ability to function socially or sense of well-being to the extent that the insured requires periodic supervision in an institutional or controlled setting for less than 50% of the time, and

(B) is determined to result in a percentage, using the method described in subsection (1), of 35% or more,

(viii) full-thickness burns resulting in consequential impairments, excluding scarring or disfigurement to all surface areas of the body other than the face, that are determined to result in a percentage, using the method described in subsection (1), of 40% or more.

Compensation for permanent impairment

3 The corporation must calculate and determine the permanent impairment compensation to which an insured is entitled under section 129 [permanent impairment compensation] of the Act by

(a) determining if the insured has sustained a catastrophic injury in accordance with section 2,

(b) determining the insured's permanent impairment rating in accordance with section 4, and

(i) the catastrophic injury in accordance with section 8 [permanent impairment compensation calculation — catastrophic injury], or

(ii) the permanent impairment rating in accordance with section 9 [permanent impairment compensation calculation — non-catastrophic injury].

Calculation of permanent impairment rating

4 The permanent impairment rating is the sum of

(a) the permanent impairment component calculated and determined in accordance with section 5, and

(b) one of the following:

(i) the enhancement component calculated and determined in accordance with section 6 [enhancement component for symmetrical body parts];

(ii) if no enhancement component is applicable, 0.

Calculation of permanent impairment component

5 (1) To determine an insured's permanent impairment component, the corporation must take the following steps in the following order:

(a) if the insured sustains a permanent impairment described in any of the following provisions, the corporation must calculate and determine the percentage that corresponds to the permanent impairment sustained by the insured in accordance with the Schedule:

(i) a percentage in relation to section 13 [wrist and hand — amputation] of the Schedule must be calculated and determined in accordance with that section;

(ii) a percentage in relation to Division 3 of Part 3 [throat and related structures] of the Schedule must be calculated and determined in accordance with section 100 [multiple impairments in Division added and multiplied by 0.7] of the Schedule;

(iii) a percentage in relation to item 7 of section 106 [other impairments to vision] of the Schedule must be calculated and determined in accordance with section 107 of the Schedule;

(iv) a percentage in relation to sections 149 to 152 [vestibulocochlear apparatus] of the Schedule must be calculated and determined in accordance with section 148 [formula to determine percentage for sections 149 to 152] of the Schedule;

(b) if the insured sustains a permanent impairment not calculated and determined in accordance with paragraph (a), the corporation must calculate and determine the percentage that corresponds to the permanent impairment sustained by the insured in accordance with the Schedule;

(c) if the insured sustains a permanent impairment that is not described in the Schedule, the corporation must calculate and determine a percentage for the permanent impairment using one or more permanent impairments described in the Schedule as a guide to establish a percentage for the permanent impairment not described in the Schedule.

(2) If, under subsection (1), the corporation calculates and determines only one percentage in the Schedule is applicable to a permanent impairment sustained by the insured, the percentage corresponding to the permanent impairment is the permanent impairment component.

(3) If an insured's permanent impairment component is determined by reference to more than one permanent impairment, the permanent impairment component must be determined using the following formula:

C = A + (B(1 − A))

where
A	=	(a)	for the first application of the formula, subject to subsection (4), the highest percentage corresponding to the permanent impairments sustained by the insured;
		(b)	for any subsequent application of the formula, the value solved for as C in the previous calculation;
B	=	(a)	for the first application of the formula, subject to subsection (4), the second highest percentage corresponding to the permanent impairments sustained by the insured;
		(b)	for any subsequent application of the formula, subject to subsection (4), the next highest percentage corresponding to the permanent impairments sustained by the insured;
C	=	(a)	subject to subsection (4), the value to be used as A in each subsequent application of the formula;
		(b)	if the B variable is the lowest percentage corresponding to the permanent impairments sustained by the insured when applying the formula, the permanent impairment component.

(4) If any of the following result in a fraction of a percentage, the fraction must be rounded to the nearest whole percentage and if a percentage ends in .5 it must be rounded up to the nearest whole percentage:

(a) the percentage corresponding to a permanent impairment sustained by the insured;

(b) the percentage determined in accordance with subsection (3) as the C variable in each subsequent application of the formula;

Enhancement component for symmetrical body parts

6 (1) Subject to section 7, the enhancement component set out in subsection (2) is added to the permanent impairment component to determine the permanent impairment rating if an anatomicophysiological deficit resulting from the accident

(a) impairs symmetrical body parts, or

(b) impairs a body part that is symmetrical to a body part that was permanently impaired before the accident.

(2) For the purposes of subsection (1), the enhancement component must be calculated using the following formula:

EC = A × 0.25

where
EC	=	the enhancement component;
A	=	subject to subsection (3), the percentage calculated and determined
		(a)	by applying section 5 as if the percentage to be calculated and determined were the permanent impairment component, and
		(b)	excluding all permanent impairments resulting from the accident except those permanent impairments that correspond to the most severely impaired symmetrical part of the insured's body.

(3) For the purposes of variable A in subsection (2), the percentage of an anatomicophysiological deficit that existed before an accident must be calculated and determined in accordance with section 5 as if the deficit resulted from the accident.

Exceptions to section 6

7 The enhancement component determined in accordance with section 6 does not apply to any of the following anatomicophysiological deficits:

(a) a deficit that affects an internal organ;

(b) a deficit that affects an organ controlling vision, balance or hearing;

(d) a deficit that affects the teeth.

Permanent impairment compensation calculation — catastrophic injury

8 If the insured sustains a catastrophic injury, the permanent impairment compensation is $264 430.

Permanent impairment compensation calculation — non-catastrophic injury

9 (1) Subject to subsection (2), the compensation for an insured's permanent impairment that is not a catastrophic injury must be calculated and determined using the following formula:

P = PIR × $167 465

where
P	=	permanent impairment compensation in dollars;
PIR	=	the insured's permanent impairment rating.

(2) Despite subsection (1), if the permanent impairment compensation determined in accordance with subsection (1) is more than $0, the minimum compensation in relation to a permanent impairment is $836.

Compensation determined at time of accident

10 (1) For the purposes of this section, "permanent" in relation to an impairment, means

(a) following a period of time sufficient for optimal tissue repair, the impairment

(i) has become static, or

(ii) has stabilized, and

(b) the impairment is unlikely to change significantly with further therapy.

(2) The corporation must not pay the compensation under section 8 or 9 until the impairment is permanent.

(3) The corporation must calculate and determine the compensation under section 8 or 9 as of the date of the accident.

Schedule

Contents
1		Definition for Schedule
Part 1 — Musculoskeletal System
2		Application regarding amputation
Division 1 — Upper Limb
3		Shoulder and arm — amputation
4		Shoulder, sternum, clavicle, rib and arm fracture and rib removal
5		Shoulder and arm — non-bony disruption
6		Shoulder and arm — ligamentous and other soft tissue disruption
7		Shoulder and arm — range of motion loss of shoulder joint complex
8		Elbow and forearm — amputation
9		Elbow and forearm — fracture
10		Elbow and forearm — non-bony disruption
11		Elbow and forearm — ligamentous and other soft tissue disruption
12		Elbow and forearm — range of motion loss
13		Wrist and hand — amputation
14		Wrist and hand — fracture
15		Wrist and hand — non-bony disruption
16		Wrist and hand — ligamentous and other soft tissue disruption
17		Wrist — range of motion loss
18		Hand — range of motion loss
Division 2 — Lower Limb
19		Pelvis — amputation
20		Pelvis — fracture and loss of motion
21		Hip and thigh — amputation
22		Hip and thigh — fracture
23		Hip and thigh — non-bony disruption
24		Hip — range of motion loss
25		Thigh — muscular atrophy
26		Knee and leg — amputation
27		Knee and leg — fracture and fracture complication
28		Knee and leg — non-bony disruption
29		Knee and leg — ligamentous and other soft tissue disruption
30		Knee — range of motion loss
31		Lower leg — muscular atrophy
32		Ankle and foot — amputation
33		Ankle and foot — fracture and fracture complication
34		Ankle and foot — non-bony disruption
35		Ankle and foot — ligamentous disruption
36		Ankle and foot — range of motion loss
Division 3 — Spine
37		Interpretation for Division
38		Cervical spine
39		Thoracic spine
40		Lumbar spine
41		Other spinal impairment
Part 2 — Central and Peripheral Nervous System
42		Definitions for Part
Division 1 — Skull, Brain and Carotid Vessels
43		Alteration of brain tissue — cerebral concussion and contusion
44		Alteration of brain tissue — post-traumatic alteration of tissue
45		Alteration of skull — post-traumatic bony alteration
46		Alteration of skull — bony deformity following depressed fracture of calvarium
47		Alteration of cerebrovascular supply
48		Functional alteration of brain — upper limb function
49		Functional alteration of brain — effect on station and gait
50		Functional alteration of brain — effect on bladder function
51		Functional alteration of brain — effect on anorectal function
52		Functional alteration of brain — sexual dysfunction
53		Functional alteration of brain — communication disorder
54		Functional alteration of brain — alteration of consciousness
55		Functional alteration of brain — alteration of higher cognitive and integrative mental functions
Division 2 — Spinal Cord
56		Interpretation for Division
57		Quadriplegia or paraplegia — ASIA Grades A and B
58		Quadriplegia or paraplegia — ASIA Grades C and D — upper limb function
59		Quadriplegia or paraplegia — ASIA Grades C and D — effect on station and gait
60		Quadriplegia or paraplegia — ASIA Grades C and D — effect on bladder function
61		Quadriplegia or paraplegia — ASIA Grades C and D — effect on anorectal function
62		Quadriplegia or paraplegia — ASIA Grades C and D — sexual dysfunction
63		Quadriplegia or paraplegia — ASIA Grades C and D — autonomic dysreflexia
Division 3 — Cranial Nerves
64		Olfactory nerves — loss and distortion of smell
65		Oculomotor nerve and eye parasympathetic input
66		Trigeminal nerves
67		Facial nerve
68		Auditory nerve tinnitus
69		Glossopharyngeal, vagal and hypoglossal impairment
70		Spinal accessory impairment
Division 4 — Peripheral Nervous System
71		Classification of motor impairment
72		Motor impairment — nerve roots
73		Motor impairment — peripheral roots — head and neck
74		Motor impairment — peripheral roots — upper limb
75		Motor impairment — peripheral roots — lower limb — thigh, leg and foot
76		Classification of sensory impairment
77		Sensory impairment — nerve roots
78		Sensory impairment — peripheral roots — head and neck
79		Sensory impairment — peripheral roots — upper limb
80		Sensory impairment — peripheral roots — lower limb — inguinal region
81		Sensory impairment — peripheral roots — lower limb — thigh, leg and foot
82		Sensory loss
83		Brachial plexus impairment
84		Lumbosacral plexus impairment
Part 3 — Maxillofacial System
Division 1 — Temporomandibular Joint (TMJ), Maxilla, Mandible and Teeth
85		Temporomandibular joint (TMJ) — range of motion loss
86		Temporomandibular joint (TMJ) — other dysfunction
87		Maxilla
88		Mandible
89		Teeth — alteration and loss
Division 2 — Fronto-Orbito-Nasal Area
90		Orbit — impairment of orbital wall causing displacement of eye
91		Orbit — disruption of medial and lateral canthus
92		Orbit — disruption of lacrimal apparatus
93		Orbit — malar bone and zygoma
94		Nasal — airflow obstruction
95		Nasal — mucosal dysfunction
96		Nasal — septal perforation
97		Nasal — paranasal sinus
98		Salivary gland
99		Tongue — anatomic loss and alteration
Division 3 — Throat and Related Structures
100		Calculation and determination of multiple impairments in Division
101		Air passage deficits — upper airway
102		Mastication and deglutition
103		Loss of taste
104		Speech impairment
Part 4 — Vision
105		Definitions for Part
106		Vision loss
107		Calculation and determination of percentage for other impairments to vision
108		Central visual acuity — testing methods
109		Central visual acuity — percentage for variable D
110		Visual field — testing methods
111		Vision meridians
112		Deficit in visual field — percentage for variable E
113		Ocular motility — testing
114		Ocular motility — percentage for variable F
Part 5 — Urogenital System and Related
115		Kidney impairment
116		Ureteric impairment
117		Bladder impairment
118		Urethral impairment
119		Tissue alteration — posterolumbar and laparotomy
120		Renal function impairment
121		Reproductive system — organ tissue disruption
122		Sexual dysfunction
Part 6 — Respiratory System
123		Respiratory system tissue disruption
124		Respiratory functional impairment
Part 7 — Digestive Tract
125		Application regarding tissue disruption and functional loss
126		Upper gastrointestinal tract disorder
127		Lower gastrointestinal tract disorder — colon and rectum
128		Lower gastrointestinal tract — anal impairment
129		Liver and biliary tract — liver tissue disruption
130		Liver and biliary tract — residual hepatic functional impairment
131		Liver and biliary tract — biliary tract dysfunction
132		Hernia-related impairment
133		Post-operative abdominal wall-related impairment
Part 8 — Cardiovascular System
134		Thoracic arterial lesion
135		Functional limitation — cardiovascular lesion
136		Peripheral arterial lesion
137		Functional limitation — peripheral arterial lesion following lower limb vascular lesion
138		Functional limitation — peripheral arterial lesion following upper limb vascular lesion
139		Venous and lymphatic lesion
Part 9 — Endocrine System
140		Hypothalamus, pituitary, thyroid and parathyroid gland dysfunction
141		Diabetes mellitus
142		Adrenal gland
Part 10 — Hematopoietic System
143		Tissue disruption — spleen
144		Tissue disruption — thymus
145		Functional impairment — red blood cells
146		Functional impairment — white blood cells
Part 11 — Psychiatric Condition, Syndrome and Phenomenon
147		Psychiatric condition, syndrome and phenomenon
Part 12 — Vestibulocochlear Apparatus
148		Formula to determine percentages for sections 149 to 152
149		Hearing loss — percentage for variable H
150		Vestibular functional impairment — percentage for variable V
151		Vestibular functional impairment — loss of labyrinth — percentage for variable V
152		Tinnitus — percentage for variable T
153		External ear canal impairment
Part 13 — Skin
154		Interpretation for Part
Division 1 — Facial Disfigurement
155		Facial disfigurement
Division 2 — Disfigurement of Skin Overlaying Rest of Body
156		Disfigurement of skin, other than facial disfigurement
157		Facial or other body region disfigurement due to discolouration
Division 3 — Disfigurement from Partial or Total Amputation
158		Application for Division
159		Disfigurement from amputation — eye
160		Disfigurement from amputation — upper limb
161		Disfigurement from amputation — lower limb

Definition for Schedule

1 In this Schedule, "non-specified abnormal healing" means an anatomic abnormality at the end of the expected healing process that is not described elsewhere in the Schedule and includes the following:

(a) a change in angulation of the fracture fragment;

(b) rotational abnormalities;

Part 1 — Musculoskeletal System

Application regarding amputation

2 In the case of an amputation described in this Part, any other permanent impairment described in this Part to the amputated body part is not included in the calculation of the permanent impairment component.

Division 1 — Upper Limb

Shoulder and arm — amputation

3 If the insured sustains a shoulder or arm amputation, the percentage in column 2 corresponds to the insured's amputation described opposite in column 1.

Item	Column 1 Shoulder or arm amputation		Column 2 Percentage
1	Forequarter amputation		60%
2	Shoulder disarticulation		56%
3	Above-elbow amputation	proximal third of the humerus	54%
		(a) middle third of the humerus (b) distal third of the humerus, or (c) both the middle third and distal third of the humerus	52%

Shoulder, sternum, clavicle, rib and arm fracture and rib removal

4 (1) If the insured sustains a sternum, clavicle, scapula, arm or rib fracture or rib removal, the percentage in column 2 corresponds to the insured's fracture or removal described opposite in column 1.

(2) In respect of item 2, a rib fracture must be documented by an imaging study.

Item	Column 1 Shoulder, rib or arm fracture or rib removal		Column 2 Percentage
1	Fracture of sternum, clavicle, scapula or humerus with non-specified abnormal healing		1%
2	Subject to subsection (2), fracture of a rib		0.5% per rib to a maximum of 2%
3	Removal of a rib		2% per rib
4	Humeral fracture	with angulation of more than 15°	5%
		with angulation of 5° to 15°	2.5%
		with shortening of more than 4 cm	5%
		with shortening of more than 2 cm to 4 cm	3%
		with shortening of 1 cm to 2 cm	1.5%
5	Chronic osteomyelitis of any upper limb bone with active drainage		3%

Shoulder and arm — non-bony disruption

5 (1) If the insured sustains a permanent shoulder or arm non-bony disruption, the percentage in column 2 corresponds to the insured's disruption described opposite in column 1.

(2) If the insured sustains a disruption described in item 2, no percentage may be added that corresponds to disruption described in item 1.

Item	Column 1 Shoulder or arm non-bony disruption		Column 2 Percentage
1	Non-bony disruption	subject to subsection (2), complete non-bony disruption or avulsion fracture affecting an upper limb	2%
1	Non-bony disruption	subject to subsection (2), partial non-bony disruption or avulsion fracture affecting an upper limb	1%
2	Non-bony disruption	rotator cuff tear, imaging positive, full thickness, with no known prior rotator cuff pathology	5%
		rotator cuff tear, imaging positive, full thickness, with known prior rotator cuff pathology	2%
		rotator cuff tear, partial thickness	2%
		distal or proximal biceps tendon rupture, with no strength deficit in supination or elbow flexion	1%
		distal or proximal biceps tendon rupture, with strength deficit in supination or elbow flexion	2%

Shoulder and arm — ligamentous and other soft tissue disruption

6 (1) If the insured sustains a permanent shoulder or arm ligamentous or other soft tissue disruption, the percentage in column 2 corresponds to the insured's ligamentous or other soft tissue disruption described opposite in column 1.

(2) In respect of items 2 and 3, confirmation must be provided by plane radiography.

(3) If a disruption described in item 3 includes a Bankart lesion, Hill-Sachs deformity or labral tear, 1% is added to the percentage in column 2.

Item	Column 1 Ligamentous or soft tissue disruption		Column 2 Percentage
1	Acromioclavicular or sternoclavicular joint injury	grade 1 separation	0%
		grade 2 separation	1%
		grade 3 separation	2%
2	Subject to subsection (2), glenohumeral instability including traumatic glenohumeral dislocation	no recurrence of dislocation within one year of the accident, without prior instability	3%
		no recurrence of dislocation within one year of the accident, with prior instability	2%
3	Subject to subsection (2), glenohumeral instability including traumatic glenohumeral dislocation	recurrence of dislocation within one year of the accident, without prior instability	subject to subsection (3), 5%
		recurrence of dislocation within one year of the accident, with prior instability	subject to subsection (3), 2%

Shoulder and arm — range of motion loss of shoulder joint complex

7 If the insured sustains a permanent range of motion loss of the shoulder joint complex, the percentage in column 2 corresponds to the insured's range of motion loss described opposite in column 1.

Item	Column 1 Range of motion loss of shoulder joint complex		Column 2 Percentage
1	Flexion-extension, which is described as motion in the scapular plane	combined range of motion of less than 61°	9%
		combined range of motion of 61° to 120°	5%
		combined range of motion of 121° to 180°	2%
		combined range of motion of more than 180°	0%
2	Abduction-adduction, which is described as motion in the coronal plane	combined range of motion of less than 61°	6%
		combined range of motion of 61° to 120°	3%
		combined range of motion of 121° to 180°	1%
		combined range of motion of more than 180°	0%
3	Internal rotation — external rotation	combined glenohumeral range of motion of less than 46°	6%
		combined glenohumeral range of motion of 46° to 90°	3%
		combined glenohumeral range of motion of 91° to 135°	1%
		combined glenohumeral range of motion of more than 135°	0%

Elbow and forearm — amputation

8 If the insured sustains an elbow or forearm amputation, the percentage in column 2 corresponds to the insured's amputation described opposite in column 1.

Item	Column 1 Elbow or forearm amputation	Column 2 Percentage
1	Elbow disarticulation, including amputation of the proximal 1/3 of the forearm	50%
2	Below-elbow amputation, involving the middle 1/3 of the forearm	47%

Elbow and forearm — fracture

9 If the insured sustains an elbow or forearm fracture, the percentage in column 2 corresponds to the insured's fracture described opposite in column 1.

Item	Column 1 Elbow or forearm fracture		Column 2 Percentage
1	Fractures of the radius, ulna or humerus, with non-specified abnormal healing		1%
2	Fracture of the radius	with angulation of more than 15°	5%
		with angulation of 5° to 15°	2.5%
		with shortening of more than 4 cm	5%
		with shortening of more than 2 cm to 4 cm	3%
		with shortening of 1 cm to 2 cm	1.5%
3	Fracture of the ulna	with angulation of more than 15°	5%
		with angulation of 5° to 15°	2.5%
		with shortening of more than 4 cm	5%
		with shortening of more than 2 cm to 4 cm	3%
		with shortening of 1 cm to 2 cm	1.5%

Elbow and forearm — non-bony disruption

10 If the insured sustains a permanent elbow or forearm non-bony disruption, the percentage in column 2 corresponds to the insured's non-bony disruption described opposite in column 1.

Item	Column 1 Non-bony disruption	Column 2 Percentage
1	Complete non-bony disruption or avulsion fracture, affecting the elbow or forearm	2%
2	Partial non-bony disruption or avulsion fracture, affecting the elbow or forearm	1%

Elbow and forearm — ligamentous and other soft tissue disruption

11 If the insured sustains a permanent elbow or forearm ligamentous or other soft tissue disruption, the percentage in column 2 corresponds to the insured's ligamentous or other soft tissue disruption described opposite in column 1.

Item	Column 1 Ligamentous or other soft tissue disruption		Column 2 Percentage
1	Ulnar and radial collateral injuries	grade 1 sprain	0%
		grade 2 sprain	1%
		grade 3 sprain	2%

Elbow and forearm — range of motion loss

12 If the insured sustains a permanent range of motion loss of an elbow, the percentage in column 2 corresponds to the insured's range of motion loss described opposite in column 1.

Item	Column 1 Range of motion loss of elbow		Column 2 Percentage
1	Flexion-extension	no movement	14%
		combined range of motion of 1° to 40°	12%
		combined range of motion of 41° to 80°	7%
		combined range of motion of 81° to 120°	4%
		combined range of motion of 121° to 135°	1%
		combined range of motion of more than 135°	0%
2	Pronation-supination	no movement	9%
		combined range of motion of 1° to 50°	4%
		combined range of motion of 51° to 100°	3%
		combined range of motion of 101° to 140°	2%
		combined range of motion of 141° to 150°	1%
		combined range of motion of more than 150°	0%

Wrist and hand — amputation

13 (1) If the insured sustains one amputation in relation to a wrist or hand, the percentage in column 2 corresponds to the insured's amputation described opposite in column 1.

(2) If the insured sustains more than one amputation in relation to a wrist or hand, the percentage in respect of this section must be determined using the following formula:

C = A + (B(1 − A))

where
A	=	(a)	for the first application of the formula, the highest percentage of the percentages in column 2 that corresponds to the description of the insured's amputations;
		(b)	for any subsequent application of the formula, the value solved for as C in the previous calculation;
B	=	(a)	for the first application of the formula, the second highest percentage of the percentages in column 2 that corresponds to the description of the insured's amputations;
		(b)	for any subsequent application of the formula, the next highest percentage of the percentages in column 2 that corresponds to the description of the insured's amputations;
C	=	(a)	the value to be used as A in each subsequent application of the formula;
		(b)	if the B variable is the lowest percentage of the percentages in column 2 that corresponds to the description of the insured's amputations, the total percentage for this section.

(a) the percentage corresponding to an amputation sustained by the insured;

(b) the percentage determined in accordance with subsection (3) as the C variable in each subsequent application of the formula;

Item	Column 1 Wrist or hand amputation		Column 2 Percentage
1	Wrist disarticulation, including the distal third of the forearm		45%
2	Transmetacarpal or metacarpophalangeal disarticulation	first metacarpal	22%
		second or third metacarpal	11% per metacarpal
		fourth or fifth metacarpal	5.5% per metacarpal
3	Trans-digital (proximal phalanx) or proximal interphalangeal disarticulation	thumb	11%
		index or middle fingers	8% per finger
		ring or small fingers	4% per finger
4	Trans-digital (middle or distal phalanx) or distal interphalangeal disarticulation	thumb	11%
		index or middle fingers	5% per finger
		ring or small fingers	3% per finger

Wrist and hand — fracture

14 If the insured sustains a wrist or hand fracture, the percentage in column 2 corresponds to the insured's fracture described opposite in column 1.

Item	Column 1 Wrist or hand fracture	Column 2 Percentage
1	Scaphoid fracture	0%
2	Scaphoid fracture with avascular necrosis	2%
3	Scaphoid fracture with non-union or pseudarthrosis	2%
4	Colles fracture with anatomic reduction	0%
5	Colles fracture with more than 15° of angulation of radius	2%
6	Avascular necrosis of lunate	2%
7	Fracture of a carpal, metacarpal or phalanx with abnormal healing	1%

Wrist and hand — non-bony disruption

15 If the insured sustains a permanent wrist or hand non-bony disruption, the percentage in column 2 corresponds to the insured's non-bony disruption described opposite in column 1.

Item	Column 1 Wrist or hand non-bony disruption	Column 2 Percentage
1	Complete non-bony disruption or avulsion fracture, affecting the wrist or hand	2%
2	Partial non-bony disruption or avulsion fracture, affecting the wrist or hand	1%

Wrist and hand — ligamentous and other soft tissue disruption

16 (1) If the insured sustains a permanent wrist or hand ligamentous or other soft tissue disruption, the percentage in column 2 corresponds to the insured's ligamentous or other soft tissue disruption described opposite in column 1.

(2) For the purposes of item 1, the carpal instability must be determined by radiological appearance, including carpal height, carpal translation and degree of joint arthrosis.

Item	Column 1 Ligamentous or other soft tissue disruption		Column 2 Percentage
1	Subject to subsection (2), carpal instability	mild	5%
		moderate	10%
		severe	14%
2	Triangular fibrocartilage complex tears		2%

Wrist — range of motion loss

17 If the insured sustains permanent range of motion loss of a wrist, the percentage in column 2 corresponds to the insured's range of motion loss described in column 1.

Item	Column 1 Range of motion loss of wrist		Column 2 Percentage
1	Flexion-extension	no movement	8%
		combined range of motion of 1° to 30°	4%
		combined range of motion of 31° to 60°	3%
		combined range of motion of 61° to 90°	2%
		combined range of motion of 91° to 100°	1%
		combined range of motion of more than 100°	0%
2	Radial deviation or ulnar deviation	no movement	6%
		combined range of motion of 1° to 25°	2%
		combined range of motion of 26° to 40°	1%
		combined range of motion of more than 40°	0%

Hand — range of motion loss

18 If the insured sustains permanent range of motion loss of a hand, the percentage in column 2 corresponds to the insured's range of motion loss described opposite in column 1.

Item	Column 1 Range of motion loss of hand		Column 2 Percentage
1	Thumb interphalangeal flexion-extension	ankylosis in faulty position	4%
		ankylosis in functional position	2%
		combined total range of motion of 1° to 40°	1%
		combined total range of motion of 41° to 70°	0.5%
		combined total range of motion of more than 70°	0%
2	Thumb metacarpophalangeal flexion-extension	no movement	2%
		combined total range of motion of 1° to 30°	1%
		combined total range of motion of 31° to 50°	0.5%
		combined total range of motion of more than 50°	0%
3	Thumb adduction	8 cm distance from flexor crease of the interphalangeal joint of the thumb to distal palmar crease overlying the metacarpophalangeal joint of the small finger	4%
		6 cm distance from flexor crease of the interphalangeal joint of the thumb to distal palmar crease overlying the metacarpophalangeal joint of the small finger	2%
		4 cm distance from flexor crease of the interphalangeal joint of the thumb to distal palmar crease overlying the metacarpophalangeal joint of the small finger	1%
		2 cm distance from flexor crease of the interphalangeal joint of the thumb to distal palmar crease overlying the metacarpophalangeal joint of the small finger	0.5%
		less than 2 cm distance from flexor crease of the interphalangeal joint of the thumb to distal palmar crease overlying the metacarpophalangeal joint of the small finger	0%
4	Thumb radial abduction	no movement	2%
		combined total range of motion of 1° to 25°	1%
		combined total range of motion of 26° to 40°	0.5%
		combined total range of motion of more than 40°	0%
5	Thumb opposition	8 cm distance from flexor crease of the interphalangeal joint of the thumb to the distal palmar crease overlying the metacarpophalangeal joint of the middle finger	0%
		6 cm distance from flexor crease of the interphalangeal joint of the thumb to the distal palmar crease overlying the metacarpophalangeal joint of the middle finger	0.5%
		4 cm distance from flexor crease of the interphalangeal joint of the thumb to the distal palmar crease overlying the metacarpophalangeal joint of the middle finger	1%
		2 cm distance from flexor crease of the interphalangeal joint of the thumb to the distal palmar crease overlying the metacarpophalangeal joint of the middle finger	2%
		less than 2 cm distance from flexor crease of the interphalangeal joint of the thumb to the distal palmar crease overlying the metacarpophalangeal joint of the middle finger	4%
6	Finger distal interphalangeal flexion-extension	no movement	1%
		combined range of motion of 1° to 35°	0.5%
		combined range of motion of 36° to 70°	0%
7	Finger proximal interphalangeal flexion-extension	no movement	1%
		combined range of motion of 1° to 65°	0.5%
		combined range of motion of 66° to 130°	0%
8	Finger metacarpophalangeal flexion-extension	no movement	1%
		combined range of motion of 1° to 55°	0.5%
		combined range of motion of 56° to 110°	0%

Division 2 — Lower Limb

Pelvis — amputation

19 If the insured sustains a pelvic amputation, the percentage in column 2 corresponds to the insured's amputation described opposite in column 1.

Item	Column 1 Pelvic amputation	Column 2 Percentage
1	Hemipelvectomy	50%

Pelvis — fracture and loss of motion

20 If the insured sustains pelvic fracture or permanent loss of motion, the percentage in column 2 corresponds to the insured's fracture or loss of motion described opposite in column 1.

Item	Column 1 Pelvic fracture	Column 2 Percentage
1	Undisplaced, non-articular, healed fracture with no other complications	0%
2	Range of motion loss of the sacroiliac joint	0%
3	Fracture involving the sacroiliac joint	2%
4	Pelvic fracture with non-specified abnormal healing	1%

Hip and thigh — amputation

21 If the insured sustains a hip or thigh amputation, the percentage in column 2 corresponds to the insured's amputation described opposite in column 1.

Item	Column 1 Hip or thigh amputation		Column 2 Percentage
1	Hip disarticulation, including proximal 1/3 of the femur		45%
2	Above-knee amputation	proximal	45%
		mid-thigh	40%
		distal	35%

Hip and thigh — fracture

22 If the insured sustains a hip or thigh fracture, the percentage in column 2 corresponds to the insured's fracture described opposite in column 1.

Item	Column 1 Hip or thigh fracture		Column 2 Percentage
1	Injuries to the acetabulum or the head of the femur requiring a prosthetic joint replacement, including any shortening of the lower limb		15%
2	Intra-articular fracture of the femur		2%
3	Fracture complication with femoral shaft fractures with angulation	more than 20°	4%
		10° to 20°	2%
4	Fracture complication with femoral shaft fractures and malrotation	more than 20°	4%
		10° to 20°	2%
5	Femoral fractures with non-specified abnormal healing		1%

Hip and thigh — non-bony disruption

23 If the insured sustains a permanent hip or thigh non-bony disruption, the percentage in column 2 corresponds to the insured's non-bony disruption described opposite in column 1.

Item	Column 1 Hip or thigh non-bony disruption	Column 2 Percentage
1	Complete non-bony disruption or avulsion fracture, affecting the hip or thigh	2%
2	Partial non-bony disruption or avulsion fracture, affecting the hip or thigh	1%

Hip — range of motion loss

24 If the insured sustains permanent range of motion loss of a hip, the percentage in column 2 corresponds to the insured's range of motion loss described opposite in column 1.

Item	Column 1 Range of motion loss of hip		Column 2 Percentage
1	Hip joint ankylosis	in a position prohibiting gait	25%
1	Hip joint ankylosis	in a position allowing gait	20%
2	Range of motion restriction in respect of flexion-extension	combined range of motion of 0° to 30°	10%
		combined range of motion of 31° to 60°	7%
		combined range of motion of 61° to 90°	3%
		combined range of motion of 91° to 120°	1%
		combined range of motion of more than 120°	0%
3	Range of motion restriction in respect of internal-external rotation	combined range of motion of 0° to 30°	5%
		combined range of motion of 31° to 60°	3%
		combined range of motion of more than 60°	0%
4	Range of motion restriction in respect of abduction-adduction	combined range of motion of 0° to 15°	5%
		combined range of motion of 16° to 45°	3%
		combined range of motion of more than 45°	0%

Thigh — muscular atrophy

25 If the insured sustains permanent thigh muscular atrophy, the percentage in column 2 corresponds to the insured's muscular atrophy described opposite in column 1.

Item	Column 1 Thigh muscular atrophy	Column 2 Percentage
1	Thigh muscular atrophy of 2 cm or more, circumference as measured 15 cm above the superior pole of the patella, including any resulting weakness, resulting from non-bony disruption, underlying fracture or objective knee condition	2%

Knee and leg — amputation

26 If the insured sustains a knee or leg amputation, the percentage in column 2 corresponds to the insured's amputation described opposite in column 1.

Item	Column 1 Knee or leg amputation		Column 2 Percentage
1	Knee disarticulation, including proximal below-knee amputation	not suitable for a patellar tendon bearing prosthesis	32%
		suitable for a patellar tendon bearing prosthesis	28%

Knee and leg — fracture and fracture complication

27 (1) If the insured sustains a knee or leg fracture or fracture complication, the percentage in column 2 corresponds to the insured's fracture or fracture complication described opposite in column 1.

(2) For certainty,

(a) the impairment described in item 1 includes any weakness, and

(b) the impairment described in item 2 includes any limb shortening or weakness.

Item	Column 1 Knee or leg fracture or fracture complication		Column 2 Percentage
1	Tibial, fibular or patellar fractures with non-specified abnormal healing		1%
2	Fracture complication in relation to knee or leg fracture	patellar fractures resulting in its surgical removal	5%
		fracture or dislocation of the patella resulting in quadriceps atrophy	2%
		tibial or fibular fractures resulting in single or multi-planar angulation of more than 15°	5%
		tibial or fibular fractures resulting in single or multi-planar angulation of 10° to 15°	2.5%
		tibial or fibular fractures resulting in malrotation of more than 20°	3%
		tibial or fibular fractures resulting in malrotation of 10° to 20°	2%
		knee, thigh or leg injuries requiring a knee arthroplasty	8%
		intra-articular fracture of the knee	2%

Knee and leg — non-bony disruption

28 If the insured sustains a permanent knee or leg non-bony disruption, the percentage in column 2 corresponds to the insured's disruption described opposite in column 1.

Item	Column 1 Knee or leg non-bony disruption	Column 2 Percentage
1	Complete non-bony disruption or avulsion fracture, affecting the knee or leg	2%
2	Partial non-bony disruption or avulsion fracture, affecting the knee or leg	1%

Knee and leg — ligamentous and other soft tissue disruption

29 (1) If the insured sustains a permanent knee or leg ligamentous or other soft tissue disruption, the percentage in column 2 corresponds to the insured's ligamentous or other soft tissue disruption described opposite in column 1.

(2) In respect of item 5, a chondral injury must be confirmed by magnetic resonance imaging or arthroscopy.

Item	Column 1 Knee or leg ligamentous or other soft tissue disruption		Column 2 Percentage
1	Cruciate or collateral ligament injuries associated with	occasional instability not interfering with occupational or recreational function	2%
		regular episodes of instability that interferes with occupational or recreational function	7%
		frequent episodes of instability that limits most occupational and recreational function	10%
		frequent episodes of instability that prohibit all occupational and recreational function	15%
2	Medial or lateral meniscal sprain or stretch with no tears		0%
3	Medial or lateral meniscal tears		2%
4	Post-traumatic patellofemoral pain syndrome with objective signs		1%
5	Subject to subsection (2), chondral injury		2%

Knee — range of motion loss

30 (1) In this section, "neutral position" means a knee straight position.

(2) If the insured sustains permanent range of motion loss of a knee, the percentage in column 2 corresponds to the insured's range of motion loss described opposite in column 1.

Item	Column 1 Range of motion loss of knee		Column 2 Percentage
1	Knee ankylosis	(a) in a faulty position, including recurvatum, varus, valgus and malrotation, and (b) with or without any of the following: (i) damage to the patella; (ii) shortening of the lower limb; (iii) muscular atrophy or weakness	20%
1	Knee ankylosis	in a functional position, with or without any of the following: (a) damage to the patella; (b) shortening by 3 cm or less; (c) altered alignment, including recurvatum, varus, valgus and rotation; (d) muscular atrophy or weakness	15%
2	Range of motion restriction in respect of flexion	5° to 60° of active range of motion	14%
		61° to 80° of active range of motion	8%
		81° to 110° of active range of motion	2%
		more than 110° of active range of motion	0%
3	Flexion contracture	less than 5° away from neutral position	0%
		5° to 9° away from neutral position	4%
		10° to 20° away from neutral position	8%
		more than 20° away from neutral position	14%

Lower leg — muscular atrophy

31 If the insured sustains permanent lower leg muscular atrophy, the percentage in column 2 corresponds to the insured's atrophy described opposite in column 1.

Item	Column 1 Lower leg muscular atrophy	Column 2 Percentage
1	Leg muscular atrophy of 1.5 cm or more, circumference as measured 15 cm below the inferior pole of the patella, including any weakness, resulting from non-bony disruption, underlying fracture or objective knee or ankle condition, not including ankylosis	2%

Ankle and foot — amputation

32 If the insured sustains an ankle or foot amputation, the percentage in column 2 corresponds to the insured's amputation described opposite in column 1.

Item	Column 1 Ankle or foot amputation	Column 2 Percentage
1	Amputation at the ankle, also known as a Symes amputation	25%
2	Midtarsal amputation, also known as a Chopart amputation	18%
3	Tarsometatarsal amputation, also known as a Lisfranc amputation	18%
4	Transmetatarsal amputation	16%
5	Amputation of all 5 toes at the metatarsophalangeal joint	9%
6	Amputation with loss of the distal end of the first metatarsal	5%
7	Bone amputation of the big toe at the metatarsophalangeal joint	3%
8	Amputation of the distal end of the fifth metatarsal	2%
9	Amputation of the big toe at the interphalangeal joint	2%
10	Total or partial amputation of the second, third, fourth and fifth toes	1% per toe

Ankle and foot — fracture and fracture complication

33 If the insured sustains an ankle or toe fracture or fracture complication, the percentage in column 2 corresponds to the insured's fracture or fracture complication described opposite in column 1.

Item	Column 1 Ankle or foot fracture or fracture complication		Column 2 Percentage
1	Fracture complication in relation to fracture of the tibia or fibula	with angulation of more than 15°	5%
		with angulation of 5° to 15°	2.5%
		with shortening of more than 4 cm	5%
		with shortening of more than 2 cm to 4 cm	3%
		with shortening of 1 cm to 2 cm	1.5%
2	Avascular necrosis of the talus		5%
3	Avascular necrosis of the navicular		3%
4	Chronic osteomyelitis of any lower limb bone with active drainage		3%
5	Post-traumatic tarsal or metatarsal deformity necessitating the use of a custom-fitted shoe or orthosis to accommodate for the condition		0.5%
6	Fractures of the tibia, fibula, tarsal or metatarsal bones with non-specified abnormal healing		1%

Ankle and foot — non-bony disruption

34 If the insured sustains a permanent ankle or foot non-bony disruption, the percentage in column 2 corresponds to the insured's non-bony disruption described opposite in column 1.

Item	Column 1 Ankle or foot non-bony disruption	Column 2 Percentage
1	Complete non-bony disruption or avulsion fracture, affecting the foot or ankle	2%
2	Partial non-bony disruption or avulsion fracture, affecting the foot or ankle	1%
3	Achilles tendon rupture	3%

Ankle and foot — ligamentous disruption

35 If the insured sustains permanent ankle or foot ligamentous disruption, the percentage in column 2 corresponds to the insured's ligamentous disruption described opposite in column 1.

Item	Column 1 Ankle or foot ligamentous disruption	Column 2 Percentage
1	Ligament injury resulting in chronic ankle instability	1.5%

Ankle and foot — range of motion loss

36 If the insured sustains permanent range of motion loss of an ankle or foot, the percentage in column 2 corresponds to the insured's range of motion loss described opposite in column 1.

Item	Column 1 Range of motion loss of ankle or foot		Column 2 Percentage
1	Ankylosis of the ankle or foot	subtalar, midtarsal, tibiotalar, also known as a pan-arthrodesis procedure	12%
		tibiotalar up to 10° of plantar flexion, with loss of inversion and eversion	8%
		subtalar and midtarsal, also known as a triple arthrodesis procedure	4%
		subtalar	3%
		tarsal-metatarsal	2.5%
		metatarsophalangeal of the big toe	1.5%
		metatarsophalangeal of any toe other than the big toe	0.5% per toe
		interphalangeal of the big toe	1%
		interphalangeal of any other toe other than the big toe	0.5% per toe
2	Range of motion restriction in relation to tibiotalar plantar flexion	1° to 10°	6%
		11° to 20°	3%
		more than 20°	0%
3	Range of motion restriction in relation to tibiotalar dorsiflexion	0 to 10°	3%
3		more than 10°	0%
4	Range of motion restriction in relation to subtalar		2%
5	Range of motion restriction in relation to midtarsal		1%
6	Range of motion restriction in relation to toe	big toe	0%
6	Range of motion restriction in relation to toe	any other toe	0%

Division 3 — Spine

Interpretation for Division

37 (1) In this Division, "bony fusion" includes using an internal fixation device or bone graft material.

(2) For the purposes of items 3, 8 to 10 and 12 in section 38, items 1, 2, 4 and 5 of section 39 [thoracic spine], items 1, 2, 4 and 5 of section 40 [lumbar spine] and items 2 and 4 of section 41 [other spinal impairment], the following is the minimum slippage:

(a) in relation to the cervical vertebrae C3 to C7, 3.5 mm;

(b) in relation to the thoracic vertebra T1 to the lumbar vertebra L4, 5 mm;

Cervical spine

38 (1) If the insured sustains a permanent cervical spine impairment, the percentage in column 2 corresponds to the insured's cervical spine impairment described opposite in column 1.

(2) For the purpose of item 5, impairment of the active range of motion of the atlanto-axial joint must be documented by the inclinometer method.

(3) For the purpose of item 6, instability must be documented by evidence of excessive motion on flexion-extension views.

(4) For the purpose of item 8, instability must be documented by radiographic instability on flexion-extension views.

Item	Column 1 Cervical spine impairment		Column 2 Percentage
1	Fusion or bony fusion of the atlanto-occipital joint, also known as C0 and C1, including post-traumatic bony alterations		6%
2	Fusion or bony fusion of the atlanto-axial joint, also known as C1 and C2, including post-traumatic bony alterations		12%
3	Non-union of the odontoid process following a fracture	(a) with evidence of radiographic instability, and (b) with minimum slippage in accordance with section 37 (2)	6%
		(a) without evidence of radiographic instability, and (b) with minimum slippage in accordance with section 37 (2)	3%
4	Uncomplicated odontoid fracture without instability		0.5%
5	Subject to subsection (2), impaired active range of motion of the atlanto-axial joint, also known as C1 and C2, following a fracture or ligamentous injury		2.5%
6	Subject to subsection (3), instability of the atlanto-axial joint, also known as C1 and C2, following a fracture or ligamentous injury	forward slippage of less than 5mm	2.5%
		forward slippage of 5mm or more	5%
7	Fusion or bony fusion of any of C3 to C7 vertebrae including, if applicable, any post-traumatic bony alterations as a result of a laminectomy, vertebrectomy or discectomy		4% per inter-space
8	Subject to subsection (4), excessive active range of motion of C3 to C7 following a ligamentous injury with a minimum measurement in accordance with section 37 (2)		2% per inter-space
9	Vertebral body non-compression fracture with a minimum measurement in accordance with section 37 (2)	with radiographic instability	6%
		without radiographic instability	3%
10	Vertebral body compression fracture with radiographic instability on flexion-extension views with a minimum measurement in accordance with section 37 (2)	loss of vertebral height, more than 50%	6%
		loss of vertebral height, from 25% to 50%	4%
		loss of vertebral height, less than 25%	2%
11	Bone alteration following a compartmented fracture of a vertebral body		0.5%
12	Vertebral body compression fracture without radiographic instability on flexion-extension views, including any range of motion restriction and with a minimum measurement in accordance with section 37 (2)	loss of vertebral height, more than 50%	3%
		loss of vertebral height, from 25% to 50%	2%
		loss of vertebral height, less than 25%	1%

Thoracic spine

39 If the insured sustains a permanent thoracic spine impairment, the percentage in column 2 corresponds to the insured's thoracic spine impairment described opposite in column 1.

Item	Column 1 Thoracic spine impairment		Column 2 Percentage
1	Vertebral body compression fracture with radiographic instability on flexion-extension views with a minimum measurement in accordance with section 37 (2)	loss of vertebral height, more than 50%	6%
		loss of vertebral height, from 25% to 50%	4%
		loss of vertebral height, less than 25%	2%
2	Vertebral body compression fracture without radiographic instability on flexion-extension views with a minimum measurement in accordance with section 37 (2), including any range of motion restriction	loss of vertebral height, more than 50%	4%
		loss of vertebral height, from 25% to 50%	2%
		loss of vertebral height, less than 25%	1%
3	Fusion or bony fusion of 2 or more adjacent thoracic vertebrae including any post-traumatic bony alterations, if applicable, as a result of a laminectomy, vertebrectomy or discectomy		4% per inter-space
4	Vertebral body non-compression fracture with a minimum measurement in accordance with section 37 (2)	with radiographic instability	6%
4		without radiographic instability	3%
5	Excessive active range of motion following a ligamentous injury as documented by radiographic instability on flexion-extension views and with a minimum measurement in accordance with section 37 (2)		2%
6	Excessive active range of motion following a costovertebral fracture or dislocation, including any range of motion restriction or radiographic instability		0.5% per spinal segment

Lumbar spine

40 If the insured sustains a permanent lumbar spine impairment, the percentage in column 2 corresponds to the insured's lumbar spine impairment described opposite in column 1.

Item	Column 1 Lumbar spine impairment		Column 2 Percentage
1	Vertebral body compression fracture with radiographic instability with a minimum measurement in accordance with section 37 (2)	loss of vertebral height, more than 50%	6%
		loss of vertebral height, from 25% to 50%	4%
		loss of vertebral height, less than 25%	2%
2	Vertebral body compression fracture without radiographic instability on flexion-extension views with a minimum measurement in accordance with section 37 (2), including any range of motion restriction	loss of vertebral height, more than 50%	3%
		loss of vertebral height, from 25% to 50%	2%
		loss of vertebral height, less than 25%	1%
3	Fusion or bony fusion of 2 or more adjacent lumbar vertebrae including, if applicable, any post-traumatic bony alterations as a result of a laminectomy, vertebrectomy or discectomy		4% per inter-space
4	Vertebral body non-compression fracture with a minimum measurement in accordance with section 37 (2)	with radiographic instability	6%
4		without radiographic instability	3%
5	Excessive active range of motion following a ligamentous injury, as documented by radiographic instability on flexion-extension views with a minimum measurement in accordance with section 37 (2)		2%

Other spinal impairment

41 If the insured sustains a permanent spinal impairment, the percentage in column 2 corresponds to the insured's impairment described opposite in column 1.

Item	Column 1 Spinal impairment	Column 2 Percentage
1	(a) Post-traumatic alteration of an intervertebral disc, including (i) disc herniation, (ii) internal disc disruption, (iii) disc space infection, or (iv) discectomy, and (b) including any range of motion restriction or radiographic instability without associated myelopathy or radiculopathy	3% per spinal segment
2	Complete laminectomy including removal of both laminae and spinous processes with a minimum measurement in accordance with section 37 (2), including any radiographic evidence of range of motion restriction or instability	2% per spinal segment
3	Partial laminectomy, laminotomy or foraminotomy, with preservation of one lamina	1% per spinal segment
4	Post-traumatic alteration of a spinous process, transverse process, lamina or zygapophyseal joint following a fracture, spondylolysis or pseudarthrosis with a minimum measurement in accordance with section 37 (2), including any radiographically documented range of motion restriction or instability	0.5% per spinal segment
5	Post-traumatic alteration of the coccyx with or without coccygectomy	0.5%

Part 2 — Central and Peripheral Nervous System

Definitions for Part

42 In this Part:

"authorized health care provider" means authorized health care provider as defined in section 1 (1) of the Enhanced Accident Benefits Regulation;

"autonomic dysreflexia" means an alteration of autonomic reflexes associated with quadriplegia or paraplegia above the T6 level that can result in sudden and sustained elevation of blood pressure;

"paraplegia" means a neurological injury that

(a) affects the trunk and lower limbs, but does not affect the upper limbs and head, and

(b) manifests with alterations in motor power and control and sensory loss below the level of injury;

"quadriplegia" means a neurological injury that

(a) affects upper and lower limbs, and

(b) manifests with alterations in motor power and control and sensory loss below the level of injury.

Division 1 — Skull, Brain and Carotid Vessels

Alteration of brain tissue — cerebral concussion and contusion

43 (1) If the insured sustains a cerebral concussion or contusion, the percentage in column 2 corresponds to the insured's cerebral concussion or contusion described opposite in column 1.

(2) The signs and symptoms of a cerebral concussion or contusion described in column 1 must be

(a) observed at the time of the accident or immediately following the accident, and

(b) documented by an authorized health care provider within 48 hours of the accident, unless the insured has a reasonable excuse not to obtain medical attention within 48 hours of the accident.

(3) A cerebral concussion or contusion must be diagnosed by an authorized health care provider.

Item	Column 1 Cerebral concussion or contusion	Column 2 Percentage
1	Subject to subsections (2) and (3), a minor cerebral concussion or contusion, with (a) post-traumatic amnesia of less than 30 minutes, or (b) a loss of consciousness of less than 5 minutes	0.5%
2	Subject to subsections (2) and (3), a moderate cerebral concussion or contusion, with (a) post-traumatic amnesia of 30 minutes or more but less than 24 hours, or (b) a loss of consciousness of 5 minutes or more but less than 1 hour	2%
3	Subject to subsections (2) and (3), a severe cerebral concussion or contusion, with (a) post-traumatic amnesia of 24 hours or more, or (b) a loss of consciousness of 1 hour or more	5%

Alteration of brain tissue — post-traumatic alteration of tissue

44 If the insured sustains a permanent post-traumatic alteration of brain tissue, the percentage in column 2 corresponds to the insured's alteration described opposite in column 1.

Item	Column 1 Post-traumatic alteration of brain tissue		Column 2 Percentage
1	Post-traumatic alteration of brain tissue	with laceration or intracerebral hematoma	2%
		with epidural hematoma	2%
		with subdural hematoma	2%
		with subarachnoid hemorrhage	5%
		with leakage of cerebrospinal fluid via one of the paranasal sinuses or via the external auditory meatus, including any elevation, craniotomy, craniectomy and plasty	5%
2	Encephalomalacia or axonal injury, including shear		5%

Alteration of skull — post-traumatic bony alteration

45 If the insured sustains a permanent post-traumatic bony alteration of the skull, the percentage in column 2 corresponds to the insured's alteration described opposite in column 1.

Item	Column 1 Post-traumatic bony alteration	Column 2 Percentage
1	Following a linear skull fracture of the base	2%
2	Following a linear skull fracture of the calvarium	1%
3	Following a craniotomy or a craniectomy	2%
4	Following trephination	0.5% per incision

Alteration of skull — bony deformity following depressed fracture of calvarium

46 If the insured sustains a permanent bony deformity of the skull following a depressed fracture of the calvarium, the percentage in column 2 corresponds to the insured's deformity described opposite in column 1.

Item	Column 1 Bony deformity impairment following a depressed fracture of the calvarium		Column 2 Percentage
1	Without dural laceration	requiring a craniectomy and cranioplasty, including elevation	4%
		requiring elevation	2%
		not requiring elevation	1%

Alteration of cerebrovascular supply

47 If the insured sustains a permanent alteration of cerebrovascular supply, the percentage in column 2 corresponds to the insured's alteration described opposite in column 1.

Item	Column 1 Alteration of cerebrovascular supply		Column 2 Percentage
1	Internal carotid artery occlusion		10%
2	Internal carotid artery stenosis	more than 70%	8%
		50% to 70%	5%
		less than 50%	2%
3	Hydrocephalus	not requiring a cerebrospinal fluid shunt	5%
		requiring a cerebrospinal fluid shunt	15%

Functional alteration of brain — upper limb function

48 If the insured sustains a permanent functional alteration of the brain that affects upper limb function, the percentage in column 2 corresponds to the insured's alteration described opposite in column 1.

Item	Column 1 Upper limb function alteration	Column 2 Percentage
1	Inability to use both upper limbs for personal hygiene and self-care with evidence of both proximal and distal upper limb neurological dysfunction	80%
2	Inability to use one upper limb for personal hygiene and self-care with evidence of both proximal and distal upper limb neurological dysfunction	60%
3	Difficulty in using both upper limbs for personal hygiene and self-care with evidence of either proximal or distal upper limb neurological dysfunction bilaterally	50%
4	Difficulty in using one upper limb for personal hygiene and self-care with evidence of either proximal or distal upper limb neurological dysfunction	40%
5	Difficulty manipulating objects with impaired prehension confined to only one of the upper limbs, while still allowing independence in personal hygiene and self-care	30%
6	Difficulty manipulating objects with no impairment in prehension in either upper limb, while still allowing independence in personal hygiene and self-care	20%
7	Upper limb clumsiness, including tremor, dysmetria or dysdiadochokinesis, with impaired prehension confined to only one of the upper limbs, while still allowing independence in personal hygiene and self-care	15%
8	Upper limb clumsiness, including tremor, dysmetria or dysdiadochokinesis, with no impairment in prehension in either upper limb, while still allowing independence in personal hygiene and self-care	10%

Functional alteration of brain — effect on station and gait

49 If the insured sustains a permanent functional alteration of the brain that affects station and gait, the percentage in column 2 corresponds to the effect on the insured's station or gait described opposite in column 1.

Item	Column 1 Effect on station or gait	Column 2 Percentage
1	Inability to stand or walk	50%
2	Ability to stand, but great difficulty walking or inability to walk	40%
3	Moderate difficulty walking on (a) irregular surfaces, (b) stairways, or (c) uneven terrain	15%
4	Slight difficulty walking	5%

Functional alteration of brain — effect on bladder function

50 If the insured sustains a permanent functional alteration of the brain that affects bladder function, the percentage in column 2 corresponds to the effect on the insured's bladder function described opposite in column 1.

Item	Column 1 Effect on bladder function		Column 2 Percentage
1	Incontinence or urinary retention	with complete loss of sphincter control	20%
		with partial loss of sphincter control	10%
		with dysfunction in the form of frequency or hesitancy	3%
2	Alteration of the bladder with enterocystoplasty		10%
3	Alteration of the bladder without enterocystoplasty		3%

Functional alteration of brain — effect on anorectal function

51 If the insured sustains a permanent functional alteration of the brain that affects anorectal function, the percentage in column 2 corresponds to the effect on the insured's anorectal function described opposite in column 1.

Item	Column 1 Effect on anorectal function	Column 2 Percentage
1	Complete loss of control	10%
2	Limited control	5%

Functional alteration of brain — sexual dysfunction

52 If the insured sustains a permanent functional alteration of the brain that results in sexual dysfunction, the percentage in column 2 corresponds to the insured's sexual dysfunction described opposite in column 1.

Item	Column 1 Sexual dysfunction	Column 2 Percentage
1	Class 1, means sexual functioning is possible with lack of awareness, excitement or lubrication or difficulty of erection or ejaculation	5%
2	Class 2, means reflex sexual functioning is possible but there is no awareness	10%
3	Class 3, means (a) infertility, (b) total absence of sexual functioning, or (c) both infertility and a total absence of sexual functioning	15%

Functional alteration of brain — communication disorder

53 If the insured sustains a permanent functional alteration of the brain that results in a communication disorder, the percentage in column 2 corresponds to the insured's communication disorder described opposite in column 1.

Item	Column 1 Communication disorder	Column 2 Percentage
1	Communication disorder that results in the insured's complete inability to understand and use language	95%
2	Communication disorder that does not affect the insured's ability to understand linguistic symbols, but severely impairs the insured's ability to use sufficient or appropriate language	70%
3	Communication disorder that does not affect the insured's ability to understand linguistic symbols, but moderately impairs the insured's ability to use sufficient or appropriate language	40%
4	Communication disorder that results in minor communication difficulties	10%

Functional alteration of brain — alteration of consciousness

54 (1) In this section "alteration of consciousness" includes adverse effects from medication.

(2) If the insured sustains a permanent functional alteration of the brain that relates to an alteration of consciousness, the percentage in column 2 corresponds to the insured's alteration of consciousness described opposite in column 1.

Item	Column 1 Alteration of consciousness	Column 2 Percentage
1	Alteration of consciousness, including stupor, coma or another disorder or disturbance that prevents the insured from performing the activities of daily living to the extent that the insured requires continuous supervision in an institutional or controlled setting	100%
2	Alteration of consciousness that impairs the insured's ability to perform the activities of daily living to the extent that the insured requires periodic supervision in an institutional or controlled setting for 50% or more of the time	70%
3	Alteration of consciousness that impairs the insured's ability to perform the activities of daily living to the extent that the insured requires periodic supervision in an institutional or controlled setting for less than 50% of the time	40%
4	Alteration of consciousness that impairs the insured's ability to perform the activities of daily living to the extent that the insured requires supervision but not in an institutional or controlled setting	15%
5	Alteration of consciousness that impairs the insured's ability to perform the activities of daily living but not to the extent that the insured requires supervision	10%

Functional alteration of brain — alteration of higher cognitive and integrative mental functions

55 (1) In this section, "higher cognitive or integrative mental functions" includes organic cerebral syndrome, dementia and neurologic deficiencies and adverse effects of medication.

(2) If the insured sustains a permanent functional alteration of the brain that results in an alteration of higher cognitive or integrative mental functions, the percentage in column 2 corresponds to the insured's alteration of higher cognitive or integrative mental functions described opposite in column 1.

Item	Column 1 Higher cognitive or integrative mental function alteration	Column 2 Percentage
1	Alteration of the higher cognitive or integrative mental functions that prevents the insured from performing the activities of daily living to the extent that the insured requires continuous supervision in an institutional or controlled setting	100%
2	Alteration of the higher cognitive or integrative mental functions that impairs the insured's ability to perform the activities of daily living to the extent that the insured requires periodic supervision in an institutional or controlled setting for 50% or more of the time	80%
3	Alteration of the higher cognitive or integrative mental functions that impairs the insured's ability to perform the activities of daily living to the extent that the insured requires periodic supervision in an institutional or controlled setting for less than 50% of the time	45%
4	Alteration of the higher cognitive or integrative mental functions that impairs the insured's ability to perform the activities of daily living to the extent that the insured requires supervision but not in an institutional or controlled setting	15%
5	Alteration of the higher cognitive or integrative mental functions that impairs the insured's ability to perform the activities of daily living but not to the extent that the insured requires supervision	5%

Division 2 — Spinal Cord

Interpretation for Division

56 In this Division, "ASIA impairment scale" means the International Standards for Neurological Classification of Spinal Cord Injury, as amended from time to time, of the American Spinal Injury Association.

Quadriplegia or paraplegia — ASIA Grades A and B

57 (1) If the insured sustains quadriplegia or paraplegia that meets the criteria for classification as Grade A on the ASIA impairment scale, the percentage in column 2 corresponds to the insured's quadriplegia or paraplegia described opposite in column 1.

(2) If the insured sustains quadriplegia or paraplegia that meets the criteria for classification as Grade B on the ASIA impairment scale, the percentage in column 3 corresponds to the insured's quadriplegia or paraplegia described opposite in column 1.

Item	Column 1 Quadriplegia or paraplegia		Column 2 Percentage ASIA impairment scale Grade A	Column 3 Percentage ASIA impairment scale Grade B
1	Quadriplegia, including (a) all anatomical and physiological deficits inherent in quadriplegia, and (b) any vertebrospinal impairments and grafting, if applicable	C5 level or higher	100%	95%
		C6 level	95%	90%
		C7 level	90%	85%
		C8 or T1 level	85%	80%
2	Paraplegia, including (a) all anatomical and physiological deficits inherent in paraplegia, and (b) any vertebrospinal impairments and grafting, if applicable	T2 to T7 level	80%	75%
		below T7	75%	70%
		conus and cauda equina lesions	70%	65%