Nobody wants to contemplate a catastrophic injury, but unfortunately thousands of Ontarians every year are seriously injured in this way.

From a personal injury standpoint, Catastrophic Injuries or Impairments are a special classification of injury that often result in substantially larger settlements due to the life altering health effects and impact they have on an individual’s ability to support him or herself in the future.

At Campisi, we specialize in litigating these types of serious injuries, which is why we’ve put together a free, comprehensive guide to provide accident victims, their loved ones, and their healthcare providers with a thorough overview of the criteria used to determine if they are catastrophically impaired. 

This article covers the basics to help you or a loved one determine what types of would qualify for this special designation of injury.

What is catastrophic impairment?

No-fault auto insurance benefits in Ontario are set out in the Statutory Accident Benefits Schedule (“SABS”) which creates three categories of injuries that determine how much money will be available to an individual after being injured in an incident:

1. Minor Injury Guideline:  This is for individuals that suffer whiplash-related injuries, muscular strains/sprains, contusions, and/or lacerations. Individuals who fall under MIG are entitled to $3,500 for their medical-rehabilitation needs.

2. Non-Catastrophic:  For more serious injuries, which may include broken bones, burns and injuries that may require income replacement, attendant care, and medical and rehabilitative treatment. Currently, the combined limit available for attendant care and med/rehab under the Statutory Accident Benefits Schedule (SABS) of the Insurance Act is $65,000. While this might seem like a lot of money, seriously injured car accident victims often exhaust these limits long before they have fully recovered from their injuries. In these cases, they must seek a determination of catastrophic impairment.

3. Catastrophic Impairment: Is a designation under the SABS that conveys entitlement to greatly enhanced accident benefits coverage to qualified insureds.  The SABS defines catastrophic impairment as one of the following types of injury:

These types of injuries are what come to mind when most people, including physicians, healthcare professionals, and unfortunately, insurance adjusters, think of catastrophic impairment. Accident victims who have suffered any of these obvious, life-altering physical injuries have a relatively clear path to securing enhanced benefits and generally are treated with respect and compassion.

Find more information on catastrophic injury by reading our blog, “What is catastrophic injury?”  Please reach out to us if you have more questions.

How a personal injury law firm can help with Catastrophic Injury designations

Ontario’s legal criteria are quite complex, leading to a lot of uncertainty and confusion over whether a person is likely to qualify under Ontario law. In addition, insurance companies will not make the determination voluntarily in any but the clearest cases. As a result, we have found that many accident victims who should be considering an application for catastrophic benefits, and many healthcare providers who should be recommending it, fail to do so because they do not have a clear understanding of the types of injuries and impairments that will qualify.  You can read more about the long road to this designation.

Qualifying for Catastrophic Impairment

In some cases, a Catastrophic Impairment designation can be determined immediately following the collision. In many cases, though, the victim has experienced one or more less drastic impairments, which might at first seem minor or temporary. However, the combined effect of these impairments can still be devastating and can lead to Catastrophic Impairment. Examples of these type of impairments include chronic pain and mobility issues from soft-tissue or orthopedic injuries, post-concussion syndrome

following a mild traumatic brain injury, and/or post-traumatic stress syndrome and other psychological disorders. Sadly, these types of victims are often viewed with suspicion and are forced to fight for access to necessary benefits.

Two other categories have been established to address situations where it is not possible to identify a single impairment that qualifies as Catastrophic Impairment. These are Whole Person Impairment (WPI) and functional impairment from a Mental or Behavioral Disorder (MBD). These remaining two catastrophic criteria are used when the claimant’s impairments do not meet any of the above-discussed categories. 

They utilize the diagnostic tools provided in the American Medical Association’s Guides to the Evaluation of Permanent Impairment (the “AMA Guides”) to assess the overall functional impairment caused by the claimant’s physical, cognitive and psychological injuries. As such, they are the most challenging criteria to evaluate and the source of most Catastrophic Impairment disputes.

The Bottom Line

If you or a loved one has been seriously injured in an accident, obviously your first concern will be your health and well-being. As part of that process, it’s important to get an assessment of your healthcare and medical rehabilitative needs, which will fall into one of three different designations, Minor Injury Guidelines, non-CAT and Catastrophic Impairment.  Due to the complex criteria, it’s a very good idea to enlist the support of a personal injury law firm with the expertise in navigating the process to ensure that you get the level of support to which you are entitled under the law.

Campisi is here to help. For more detailed information on Catastrophic Impairments, be sure to download our comprehensive guide for free, and contact Campisi for a free consultation.