Catastrophic injury
Why is it important to be suffering from a "catastrophic impairment"? There are many increased benefits provided under the law for victims who sustained a "catastrophic impairment" as defined under the Insurance Act and the SABS Schedule. Generally, the amount of treatment and rehabilitation coverage is increased to one million dollars, and supervision or attendant care benefit is also increased to another one million dollars if a car accident occurred before June 1, 2016, thereafter, the maximum coverage may be cut in half unless you have bought extra optional insurance. More recently as of our update of June 2021, these maximum caps have been restored to about the way they were before June 1, 2016. If you have many years of life expectancy ahead, these increased benefits are crucial to your safety and well-being.
Fewer than 5% of auto injury cases involve a "Catastrophic Impairment". There are some 60,000 persons injured in auto accidents in Ontario every year. About 1% are obviously catastrophic immediately without dispute with the insurance companies. There are others who are initially not obviously catastrophic, but subsequently suffered "marked" disability in their day to day functioning, their social functioning, or adaptation back to a working life, such that they may become catastrophically impaired under the definition of "Catastrophic Impairment". Some other victims suffering more than 55% "Whole Person Impairment" may also be found to be catastrophically impaired. This definition has undergone significant changes which makes it more difficult for some victims while easier for others, but overall, the changes reduce the number of injured persons who will qualify for this level of care.
How would you know that you may have suffered a catastrophic impairment? The full answer is very, very complex. However, here is a rough guide for your information in the event that the issue has not been brought up or discussed with your qualified lawyers. Please note that the law does not allow licensed paralegals to represent you on catastrophic cases, and therefore in our view, they are also not allowed to represent you on cases while you are fighting to win the designation that you are catastrophically impaired.
Consider 1) the pain your are under; 2) the activities that you can no longer do; 3) the sadness you profoundly feel; 4) your hopelessness in being able to do any kind of work in the future, etc... Ask yourself, how different are you from the way you were before the accident? If you feel personally or subjectively that things have changed more than about 55% from the way you were, then you should consider raising this possibility that you are catastrophically impaired. You should ask for a catastrophic impairment assessment, which is typically paid for by the insurance company without costs to you. If you are not sure of what to do, then be on the safe side, raise the issue of Catastrophic Impairment.
In fighting for catastrophic impairment, you should know that even your own doctors and experts may miss important impairments that may be used to add up and increase your WPI (Whole Person Impairment) ratings to the threshold required. In one case, we were able to identify the issue of urinary incontinence which was not rated by catastrophic medical experts because they did not know whether the accident caused it. At the hearing of the issue, the arbitrator agreed that the accident caused urinary incontinence and an WPI rating was accepted. Suffice to say, the law on catastrophic impairment continues to be evolving and very complex. The extensive expertise is important to protect a seriously injured person.
Why is it important to be suffering from a "catastrophic impairment"? There are many increased benefits provided under the law for victims who sustained a "catastrophic impairment" as defined under the Insurance Act and the SABS Schedule. Generally, the amount of treatment and rehabilitation coverage is increased to one million dollars, and supervision or attendant care benefit is also increased to another one million dollars if a car accident occurred before June 1, 2016, thereafter, the maximum coverage may be cut in half unless you have bought extra optional insurance. More recently as of our update of June 2021, these maximum caps have been restored to about the way they were before June 1, 2016. If you have many years of life expectancy ahead, these increased benefits are crucial to your safety and well-being.
Fewer than 5% of auto injury cases involve a "Catastrophic Impairment". There are some 60,000 persons injured in auto accidents in Ontario every year. About 1% are obviously catastrophic immediately without dispute with the insurance companies. There are others who are initially not obviously catastrophic, but subsequently suffered "marked" disability in their day to day functioning, their social functioning, or adaptation back to a working life, such that they may become catastrophically impaired under the definition of "Catastrophic Impairment". Some other victims suffering more than 55% "Whole Person Impairment" may also be found to be catastrophically impaired. This definition has undergone significant changes which makes it more difficult for some victims while easier for others, but overall, the changes reduce the number of injured persons who will qualify for this level of care.
How would you know that you may have suffered a catastrophic impairment? The full answer is very, very complex. However, here is a rough guide for your information in the event that the issue has not been brought up or discussed with your qualified lawyers. Please note that the law does not allow licensed paralegals to represent you on catastrophic cases, and therefore in our view, they are also not allowed to represent you on cases while you are fighting to win the designation that you are catastrophically impaired.
Consider 1) the pain your are under; 2) the activities that you can no longer do; 3) the sadness you profoundly feel; 4) your hopelessness in being able to do any kind of work in the future, etc... Ask yourself, how different are you from the way you were before the accident? If you feel personally or subjectively that things have changed more than about 55% from the way you were, then you should consider raising this possibility that you are catastrophically impaired. You should ask for a catastrophic impairment assessment, which is typically paid for by the insurance company without costs to you. If you are not sure of what to do, then be on the safe side, raise the issue of Catastrophic Impairment.
In fighting for catastrophic impairment, you should know that even your own doctors and experts may miss important impairments that may be used to add up and increase your WPI (Whole Person Impairment) ratings to the threshold required. In one case, we were able to identify the issue of urinary incontinence which was not rated by catastrophic medical experts because they did not know whether the accident caused it. At the hearing of the issue, the arbitrator agreed that the accident caused urinary incontinence and an WPI rating was accepted. Suffice to say, the law on catastrophic impairment continues to be evolving and very complex. The extensive expertise is important to protect a seriously injured person.