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  • Catastrophic Ocf19 Form

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Return this form to: Application for Determination of Catastrophic Impairment (OCF-19) Use this form for accidents that occur on or after November 1, 1996 Claim Number: Policy Number: Date of Accident:.

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7 Mental, or Behavioural Impairment, Excluding Traumatic Brain Injury, Combined with a Physical impairment which results in 55 percent or more impairment of the whole person.

8. An impairment that results in a class 4 (marked impairment) in three or more areas of function or a class 5 (extreme impairment) in one or more areas of function in ance with the AMA Guides, 4th edition, due to a mental or behavioural disorder.

A motor vehicle collision survivor is considered to have sustained a catastrophic impairment if they meet at least one of the following criteria: Paraplegia or Tetraplegia. Severe impairment of ambulatory mobility or use of an arm; or amputation. Loss of Vision of Both Eyes.

A catastrophic injury is generally defined as severe injury to the brain, spine or spinal cord, and may also involve fractures of the skull or spinal column. Catastrophic injuries can result directly from violent trauma in an accident, or indirectly from complications associated with the original injury.

2. Severe impairment of ambulatory mobility or use of an arm, or amputation and includes specific criteria including the Spinal Cord Independence Measures for lower limb amputations.

A catastrophic injury is a physical injury or illness that is regarded as extreme or particularly serious, has a considerable impact on the victim of the injury or illness and needs a considerable amount of medical treatment. Catastrophic injuries may not always be permanent, but take months or years to heal.

The individual must meet one of the following criteria to qualify for Catastrophic Impairment: Vegetative State (VS or VS*), one month or more after the accident, Upper Severe Disability (Upper SD or Upper SD*) or Lower Severe Disability (Lower SD or Lower SD*), six months or more after the accident, or.

Criteria for Catastrophic Impairment Determinations Paraplegia or Tetraplegia. Severe impairment of ambulatory mobility or use of an arm; or amputation. Loss of Vision of Both Eyes. Traumatic Brain Injury meeting the Glasgow Outcome Scale-Extended (GOS-E) criteria.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232