Understanding Catastrophic Injuries in Ontario
In Ontario, the landscape of “no-fault” or “first party” auto insurance coverage for people injured in motor vehicle accidents is governed by the Statutory Accident Benefits Schedule (SABS). These benefits are intended to provide for the immediate needs of individuals injured in motor vehicle accidents. Injured people have access to benefits for medical and rehabilitation expenses, and attendant care, for up to five years after the accident. If the person suffers catastrophic injuries, the five year limit is waived, and the dollar limits on the medical, rehabilitation and attendant care benefits are extended.
The term "catastrophic injuries" is very specifically defined in the SABS. This blog post aims to clarify what constitutes a catastrophic injury under SABS, the criteria for classification, and the benefits available to those affected.
What is a Catastrophic Injury?
A catastrophic injury is defined as a severe injury resulting from a motor vehicle accident that leads to significant and often permanent impairment in an individual’s ability to perform daily activities. These injuries can drastically change a person's life, affecting not only their physical capabilities but also their emotional and cognitive well-being.
Criteria for Catastrophic Injury Classification
Under SABS, a catastrophic injury is determined based on specific criteria. Some of these can be applied in the immediate or very short term after the accident, while others have specific waiting periods.
The immediate criteria include:
Severe Physical Impairments such as:
Paralysis (e.g., quadriplegia or paraplegia)
Loss of a limb
Significant loss of limb function
Severe loss of vision
Traumatic brain injuries, with injuries visible on a scan or other imaging:
There are additional assessments of traumatic brain injury, with criteria requiring specific waiting periods of one month to one year
Post Two Year Criteria
There are other criteria which apply to catastrophic impairment. These require either a physician’s assessment, at least three months after the accident which indicates a whole person impairment rating of equal to greater than 55% or waiting a full two years after the accident before assessing the injured person.
Combination of multiple physical impairments:
Multiple physical impairments may be combined to obtain a whole person impairment rating of equal to greater than 55%.
Mental or behavioural impairments:
Mental or behavioural impairments that in combination with physical impairments, result in a whole person impairment rating of equal to greater than 55%.
Mental or behavioural impairments that result in marked impairment in three or more areas of function or extreme impairment in one or more areas of function.
Mental or behavioural impairments that result in reasoning or decision-making capabilities.
Benefits for Catastrophic Injuries
Individuals classified with catastrophic injuries are eligible for a more extensive range of benefits under SABS. These benefits can include:
Medical and Rehabilitation Expenses: Enhanced coverage and extended limits for ongoing medical treatment, rehabilitation services, and therapies necessary for recovery and adaptation.
Attendant Care Benefits: Financial support for caregivers who provide essential assistance to individuals unable to care for themselves.
Income Replacement Benefits: Assistance for those who are unable to work due to their injuries, ensuring some financial stability during recovery.
Caregiver Benefits Assistance for those who were living with and providing primary care for a person in need of care, and who cannot do so because of the accident
Housekeeping and home maintenance Benefits: Support for individuals who require help with household tasks due to their injuries.
Conclusion
Navigating the aftermath of a catastrophic injury can be overwhelming. Understanding the classification of catastrophic injuries under Ontario's SABS is crucial for affected individuals and their families. Recognizing the available benefits can help in making informed decisions about recovery and care. If you or someone you know has suffered a catastrophic injury, it is essential to seek professional guidance to ensure you receive the support you need during this challenging time.
