Catastrophic Impairment in Ontario
Injuries are a common part of serious motor vehicle accidents. That said, not all injuries are created equally. Some injuries are surface level and only require time to heal. Other injuries are more severe, necessitating a lifetime of special help or treatment. These devastating injuries are known as catastrophic injuries.
There are specific guidelines used to identify catastrophic injuries in Ontario. If the insurance company determines that your condition meets the catastrophic impairment criteria, it could dramatically impact the amount of compensation you are entitled to.
Understanding Catastrophic Impairment Criteria
To obtain a designation of catastrophic impairment in Ontario, you must first meet the catastrophic impairment criteria. This designation is important, as it can result in a significant increase in the benefits available in your claim. A thorough medical assessment and evaluation of your condition is required. You can access the Ontario government’s OFC-19 form here.
In every accident or trauma case, there is a framework known as the Statutory Accident Benefits Schedule (SABS) that each injury falls into. Within this framework are different categories. The more severe or life-altering the category of injury, the more compensation that might be available. A patient must first qualify for benefits. A lawyer or attorney can help you document and prove your case and negotiate a fair settlement for your insurance claim.
The lowest tier of injury is known as the Minor Injury Guideline. These so-called “minor injuries” can still have significant consequences like whiplash and severe lacerations. These injuries could result in up to $3,500 for rehabilitation. The second tier of injuries carries up to $65,000 of rehabilitation and attendant care costs over the course of five years.
The highest tier of injury under SABS is a catastrophic injury. With a designation of a catastrophic impairment, you could receive up to $1 million for rehabilitation and attendant care costs for the rest of your life. This permanent designation is based on the medical assessment of your functional limitation and physical restriction, which can affect your work capacity. The severity level of the injury is a key factor. To determine the level of impairment, medical professionals must evaluate your condition and document their findings. A disability can also have a significant financial impact and result in a quality of life reduction. The goal is to achieve recovery from your trauma and rehabilitate. The insurance company must provide proper coverage so your treatment requirements are covered. This process can be complex and may require a patient to suffer through a long period of treatment.
SABS Catastrophic Impairment Criteria
There are 8 different facts that go into whether an injury qualifies as catastrophic. These factors are listed in the Ontario Regulations. Each of these factors is covered in detail in SABS and include many different conditions. These conditions could include:
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- paralysis,
- blindness,
- traumatic brain injuries,
- amputation, or
- mental impairment to name a few.
These guidelines have a degree of subjectivity to them, which can result in an uneven distribution of benefits from one case to another. A catastrophic injury lawyer could help ensure that you are treated fairly, and that you obtain the designation you are entitled to.
Who makes the decision?
Ultimately, the designation of a catastrophic impairment in Ontario is made by the insurance company. That said, the documentation provided by your medical care providers will have an enormous impact on your chances.
The insurance company will review the affidavit and records provided by the physicians or other medical professionals. This could include reports from neuropsychologists, speech pathologists, or any other medical professional involved your treatment. The important thing is to provide context during the decision-making process. For example, a speech pathologist could give vital insight into highlighting the effect a traumatic brain injury has had on your speech.
The Final Decision About Catastrophic Impairment Cases in Ontario
After the relevant information is submitted to the insurance company, they will make their decision. Certain conditions will automatically result in a designation of catastrophic impairment. These include paraplegia or childhood brain injuries among other examples.
For injuries that are not automatically considered catastrophic, the insurance company could require additional evaluation before they make their final decision. It is not uncommon for the insurer to require a series of assessments from their chosen doctors to confirm the existence of the catastrophic condition. If the assessments back up the existence of the catastrophic impairment, the insurance company could make the determination you are looking for.
Pursuing a designation of catastrophic impairment in Ontario can be a long, drawn-out process. While success is never guaranteed, you could find a favorable outcome more likely by following the guidance of a catastrophic injury lawyer.
