Catastrophic Injury Claims in Ontario

What catastrophic impairment means

Under Ontario's Statutory Accident Benefits Schedule (SABS), certain injuries from a motor vehicle accident can be designated a catastrophic impairment. The designation is a legal test set out in the regulation, not a general description of how serious an injury feels, and it is assessed against specific medical criteria.

Injuries that may qualify

The criteria depend on the date of the accident. For recent accidents they include, in summary:

• Paraplegia or tetraplegia, and certain other spinal cord injuries that severely affect walking
• Amputation, or permanent loss of use of an arm or a leg
• Loss of vision in both eyes
• Traumatic brain injury meeting the regulation's outcome-scale criteria, with supporting imaging or clinical findings
• Physical impairments that combine to a high whole-person rating under the regulation's method
• Marked or extreme mental or behavioural impairment, assessed under the regulation's criteria

Whether an injury qualifies depends on the medical evidence and the exact wording of the regulation that applies to your accident date.

Why the designation matters

Accident benefit limits for medical, rehabilitation and attendant care are significantly higher for a catastrophic impairment, and they can remain available for much longer. Other benefits, such as case management and home modification, may also become available. The designation can also be significant in a tort claim against the at-fault driver.

How the process works

1. Ongoing treatment and documentation from treating doctors and therapists.
2. An application for determination of catastrophic impairment (OCF-19), completed with a physician or other authorized health practitioner.
3. The insurer may arrange its own assessments before deciding.
4. If the insurer denies the designation, the dispute can be taken to the Licence Appeal Tribunal.

Some injuries cannot be fully assessed until months after the accident. We track the relevant time points so an application is not made too early or left too late.

Supporting the family

Catastrophic injury claims often involve family members who are providing care, managing finances and dealing with insurers. We can speak with family members, with the injured person's permission, and coordinate with treatment providers, rehabilitation case managers and, where needed, a litigation guardian.

Deadlines that apply

• Notify your own auto insurer within 7 days of a motor vehicle accident, and send the accident benefits application within 30 days of receiving the forms, or as soon as practicable.
• Most lawsuits must be started within 2 years of the date you knew or ought to have known of the claim (Limitations Act, 2002).
• Disputes over accident benefits generally go to the Licence Appeal Tribunal, which has its own time limits after a denial.
• Where a road defect or municipal maintenance is involved, written notice to the municipality is generally required within 10 days.

A late notice does not always end a claim, but it can create problems that are avoidable. Call early, even if you are still in treatment.

Fees

Injury consultations are free. Most injury files are handled on a contingency fee under a written agreement, explained before you sign. See how injury fees, costs and disbursements work.