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What Meets Catastrophic Impairment Criteria in Ontario?

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What Meets Catastrophic Impairment Criteria in Ontario?

Don’t delay discussing your matter with us to find out how to build a winning case.

Please enable JavaScript in your browser to complete this form.

You don’t pay us unless we win your case. No Out of pocket expenses required.

Note: Your Privacy is Safe with us. We will never disclose your information to external parties.
catastrophic impairment criteria

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 a significant increase in the benefits available in your claim. You can access the Ontario government’s OFC-19 form here.

In every injury case, there is a framework known as the Statutory Accident Benefits Schedule (SABS) that each injury falls into. Within this framework are there different categories. The more serious the category of injury, the more compensation that might be available.

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 rehabilitation and attendant care costs for the rest of your life.

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:

    • 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.

Disclaimer: The content of this article is a general guideline made available for educational purposes only and is not intended to be used as legal advice for the reader’s specific situation nor in general. By reading our blog and website content, the reader acknowledges the above and understands there is no lawyer-client relationship created between you and Himelfarb Proszanski through this content. To get specific legal advice, we encourage you to book a free consultation with one of our lawyers to clarify the legal aspects of your situation.

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Please enable JavaScript in your browser to complete this form.

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Note: Your Privacy is Safe with us. We will never disclose your information to external parties.

Timing is Critical. Help is Free.

Don’t delay discussing your matter with us to find out how to build a winning case.

Please enable JavaScript in your browser to complete this form.

You don’t pay us unless we win your case. No Out of pocket expenses required.

Note: Your Privacy is Safe with us. We will never disclose your information to external parties.

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Sherene AlySherene Aly
16:02 23 Mar 24
I was very pleased with my decision to retain David and his team for my case. Melissa Gizzo was simply amazing and was able to secure a fair settlement for me.
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Experienced and excellent law firm. Their lawyers are wonderful, articulate, dilligent, amicable, calm, respectful, responsible, resourceful and have good human and customer relationships Especially DAN HOLLAND 👌 He is an amazing lawyer as regards dealing with any of the Accident case.I was involvedIn an accident in 2019 February. He was God sent as he dutifully and relentlessly worked hard until the case was settled
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My mom was involved in an accident impacting her daily life and ability to work. Dan Holland has worked with us during the duration of our case and has been helpful in fighting for her and supporting us, and organizing the things we needed. Our family is incredibly grateful of the outcome Dan was able to obtain for us. I would highly recommend him!
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I'm so happy I chose Mena Brar and her team represet us . We could not ask for a better team she is so kind, loyal, and honest. she spoke to me as an equal and made me feel as if my case was definitely important and that I deserved to be fairly compensated. I appreciate you. Did it for me and how this will help me get back on track with my life. keep helping others. You are doing amazing works, Mena Brar. I wish you all the best.
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Andrew CoutoAndrew Couto
23:10 21 Nov 23
I'm so happy I chose David as my lawyer. I spoke to a few lawyers before finding David and I noticed majority of them spoke to me in a way that felt demeaning or that my case wasn't big enough or important enough to take. One phone call with David and my opinion on lawyers changed. He spoke to me as an equal and made me feel as if my case was definitely important and that I deserved to be fairly compensated. The whole process was wonderful. From dealing with David's law clerk Ingrid whom is an amazing and kind woman to his legal assistant Melissa whom is another amazing kind and talented young woman. I was so stressed about this case but from day 1 they helped ease that stress and always answered all my questions promptly and respectfully. I couldn't believe David got me to mediation within 6 months of being cut off my LTD and got me a settlement way beyond my expectations. I can't say enough good things about this law firm but I guarantee you that if you need a lawyer to fight for you David is your guy! . Believe me when I say this is the law firm for anyone dealing with personal injuries especially LTD denial claims. Thank you so much to David, Ingrid and Melissa you truly don't know how much I appreciate all you did for me and how this will help me get back on track with my life. Keep helping others you guys are doing amazing work! I wish you all the best!
Rose RegazziRose Regazzi
21:15 11 Oct 23
I sustained a relatively painful injury, affecting me long term.I wouldn't otherwise had pursued it, as it involved a relatively large corporation, but felt it necessary to do so. However, many lawyers were daunted, with one, who actually referred me to HIMPRO.I was connected with Dan Holland, who reviewed the case, provided with me realistic expectations, sound advice and had a willingness to move forward and represent me.His calm and professional demeanor, brought me to a place of reassurance. His ease in addressing all facets of this process, clearly demonstrated a wealth of experience. There was never any hesitation, when being challenged, and felt my best interest was always in the forefront.This case has since been resolved, to my complete satisfaction.Without reservation, HIMPRO (and Dan Holland, in particular), would be the only firm I would recommend for these type of cases.
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