Catastrophic

The Statutory Accident Benefits Schedule (SABS) in Ontario has established a framework for dealing with injuries as a result of a motor vehicle accident.  The injury framework has 3 categories:

• Minor Injuries – these include sprains/strains, abrasions, minor lacerations, partial tendon/ligament tears, “and any clinically associated sequelae” – these are eligible for $3500 in rehabilitation
• Serious Injuries – which include fractured bones, completely torn ligaments/tendons, injuries that require surgery, etc. – these injuries are eligible for $65000 in rehabilitation benefits and attendant care benefits for up to 5 years.
• Catastrophic Injuries – life-changing injuries which prevent the claimant from resuming a normal life. Examples include paralysis, blindness, traumatic brain injuries, or severe mental impairment, among others.   Injuries that fall in this category are eligible for up to $1 million in rehabilitation and attendant care for life.

When the paperwork is filed for a Catastrophic Impairment claim, if there is a disagreement between the insurance company and the claimant as to whether the injury sustained has indeed caused a true catastrophic impairment, both the insurance company and the claimant conduct catastrophic impairment assessments to determine whether the injuries meet the threshold.

A Catastrophic Impairment Assessment is a series of evaluations by specialists to determine the level of impairment and disability caused by a claimant’s MVA-related injuries.  These injuries can include neurological, psychological, neuropsychological, visual, spinal cord, and orthopedic among others.  The purpose of the CAT assessment is to determine whether the claimant has suffered a combination of physical and mental impairments as a result of the accident which results in 55% whole person impairment or greater.

As an insured person injured in an MVA in Ontario you are entitled to benefits regardless if you are at fault or not.   As it relates to catastrophic injuries, this is especially true and in order to help you access the maximum benefits available to you CAT assessments are required.