For any person who suffers a serious personal injury, the event that caused their misfortune is clearly a catastrophe. In the English language, the word generally refers to a sudden event or incident causing great suffering or destruction.
But within the law, catastrophic impairment has a very particular meaning, and there are significant financial implications if an injured person receives this designation in court proceedings.
When a person’s injuries clearly fit this definition, questions most often turn to deciding liability and calculating the compensation to which they are entitled. However, if there is any doubt about whether an injury fulfills the requirements for this designation, insurance companies frequently try to contest these claims to avoid long-term obligation to pay accident benefits payments and tort damages.
Not all lawyers will make every effort to secure this designation for accident victims whose injuries are near the threshold. But at Howie, Sacks & Henry LLP, we pride ourselves on going the distance for our clients. We build strong cases, bolstered by expert medical opinions, to support your catastrophic injury claim so that you can access the full extent of the compensation you need and deserve.
In the wake of a life-altering injury, you or your loved one may despair over a frighteningly uncertain future. Trust the catastrophic injury lawyers at HSH to show you why Hope Starts Here.
At A Glance
- Catastrophic impairment is a specific legal term.
- An accident victim who is designated as catastrophically impaired is eligible to access the maximum amount of accident benefits provided by Ontario’s Statutory Accident Benefits Schedule (SABS)
- Insurers often contest a catastrophic impairment designation if an accident victim’s injuries do not clearly pass the threshold outlined in the law
- An HSH catastrophic injury lawyer can help you maximize your benefits by building a strong case supported by expert medical opinion
What Are Catastrophic Injuries?
A catastrophic injury generally involves long-term disability. Accident victims may suffer permanent damage to one or more parts of the body that significantly impacts their functional abilities or their capacity to live as they had before their injury.
Catastrophic injuries may include:
- Traumatic brain injuries (TBIs)
- Spinal cord damage resulting in significant loss of function
- Soft tissue, vascular and/or nerve damage causing or necessitating amputations
- Eye/brain injuries resulting in functional blindness
- A combination of physical injuries resulting in substantial whole body impairment
- Injuries resulting in new or worsening mental or behaviourial disorders that seriously impair functioning and independence
How Is Catastrophic Impairment Defined By Law?
In order for an injury to be deemed to be catastrophic according to Ontario law, it must meet criteria outlined in specific medical journals or manuals, and/or be confirmed through testing, assessment or evaluation by qualified medical experts.
According to Ontario’s Statutory Accident Benefits Schedule (SABS), a catastrophic impairment designation will result from any of the following:
- Paraplegia or tetraplegia
These conditions are established according to a permanent grade on the ASIA Impairment Scale. Depending on their ASIA scale grade, the injured person may also: be required to score a particular measure on the Spinal Cord Independence Measure (Mobility Indoors); require urological surgical diversion, an implanted device, or intermittent or constant catheterization in order to manage a residual neuro-urological impairment; or, demonstrate impaired voluntary control over anorectal function that requires a bowel routine, a surgical diversion or an implanted device.
- Severe impairment of ambulatory mobility or use of an arm, or amputation.
The injury must meet the following criteria: trans-tibial or higher amputation of a leg; amputation of an arm or another impairment causing the total and permanent loss of use of an arm; or severe and permanent alteration of prior structure and function involving one or both legs as established by specific measures/scales.
- Loss of vision in both eyes
The disability must meet the following criteria: it is present even with the use of corrective lenses or medication to a degree greater than acuity listed in the Snellen Chart or an equivalent chart; or, the greatest diameter of the field of vision in both eyes is 20 degrees or less. The loss of vision must not be attributable to non-organic causes.
- Traumatic brain injuries
For these injuries, criteria differs according to the age of the injured person at the time of the accident. If the insured person was 18 years of age or older at the time of the accident, a traumatic brain injury must show positive findings on a computerised axial tomography scan, a magnetic resonance imaging or any other medically recognized brain diagnostic technology indicating intracranial pathology; or, particular ratings on the the Glasgow Coma Scale one month, six months, or nine months or more after the accident. If the insured person was under 18 years of age at the time of the accident, their injury would require: being accepted for admission, on an in-patient basis, to a public hospital based on recognized testing indicating intracranial pathology that is a result of the accident; or, particular ratings on the King’s Outcome Scale for Childhood Head Injury or a level of function that is not age-appropriately independent and requires in-person supervision or assistance for physical, cognitive or behavioural impairments for the majority of the waking day.
- Physical impairment or a combination of physical impairments
The injury/injuries must result in 55 per cent or more physical impairment of the whole person in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment.
- Mental or behavioural impairment, excluding traumatic brain injury
Determined in accordance with rating methodology in the American Medical Association’s Guides to the Evaluation of Permanent Impairment, this impairment’s score, when combined with a physical impairment score, must result in 55 percent or more impairment of the whole person.
- Marked or extreme impairment due to mental or behavioural disorder in one or more areas of function that precludes useful functioning, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment.
The latter three categories only apply if:
- At least two years have passed since the accident; or,
- A physician’s assessment occurring three months or more after the accident reveals the insured person’s condition is unlikely to improve to less than 55 percent impairment of the whole person or to improve to less than a class 4 impairment (marked impairment) in three or more areas of function.
Why Is A Catastrophic Impairment Designation So Important?
Successive provincial governments have made cuts to the accident benefits outlined in SABS regulations. If an injury is deemed to be non-catastrophic, accident victims are only able to draw a maximum of $65,000 for combined medical, rehabilitation and attendant care over five years. A catastrophic impairment designation allows an injured person to claim up to $1 million over a lifetime.
Personal injury lawyers have long advised people to purchase optional benefits to increase their level of coverage to account for inflation and other rising costs associated with medical care. A seriously injured person, particularly one who may not make a full recovery within months or years, if ever, can quickly exhaust these benefits. They may then be required to pay out of pocket for continued treatment and care.
While a person who is not at fault for the accident (or only partially at fault) can make a tort claim for damages to supplement compensation, a person found to be at fault will not have this option.
Finally, when making a tort claim for damages, demonstrating catastrophic impairment is often crucial to surpassing the deductible/threshold for general damages such as pain and suffering. As of 2024, unless an accident victim’s award for pain and suffering is assessed at more than $153,509.39, a deductible of $46,053.20 will apply to this head of damages.
We can help
Life is expensive. Life with a debilitating injury or permanent disability is far more costly. When you suffer a life-changing accident that causes you significant and lasting harm, you need an advocate who knows exactly what’s needed to support your claim for maximum compensation. At HSH, when we speak to accident victims with injuries at or near the threshold for a catastrophic impairment designation, we explain exactly what is on the line. Choosing a catastrophic injury lawyer to represent them will be a pivotal moment for their case.
For a quarter of a century, our team of knowledgeable, skilled, and experienced personal injury lawyers have earned a reputation for taking on even the most challenging and complex cases. In our mind, settling for less than what you deserve is never in your best interest. That’s why we always bring trial-ready cases to the negotiating table.
Insurers and defence counsel know well that an HSH catastrophic injury lawyer is always prepared to go the distance. With our network of experts, we are able to connect our clients with medical professionals who understand critical details when assessing significant and complex injuries.
But we also understand that you are much more than your injury. With great empathy, compassion, and attentive care, our team makes time to build relationships with our clients that help us understand them as individuals. Recognized as one of Canada’s top personal injury firms by both our peers and our clients, we are proud that many people we come to represent first hear of us through word-of-mouth recommendations by people they trust.
If you or a loved one has been seriously injured, you need legal advice to make an informed decision about how to best protect your right to maximum compensation.
Contact the catastrophic injury team at Howie, Sacks & Henry LLP. When you have us on your side and at your side, you’ll have a tireless and dedicated advocate to support you on your journey towards justice.
