For victims of a car accident that are deemed to have catastrophic impairment these caps are much higher. So, how is catastrophic impairment defined and diagnosed, and what sort of benefits can be expected in such cases?
According to the Ontario Statutory Accident Benefits Schedule, determination of catastrophic impairment can only be conducted by a physician, who will then send their findings to the victim’s insurance provider.
However, the Schedule also thoroughly defines what can legally be considered catastrophic impairment as follows:
(2) For the purposes of this Regulation, a catastrophic impairment caused by an accident is,
(a) paraplegia or quadriplegia;
(b) the amputation of an arm or leg or another impairment causing the total and permanent loss of use of an arm or a leg;
(c) the total loss of vision in both eyes;
(d) brain impairment that results in,
(i) a score of 9 or less on the Glasgow Coma Scale, or
(ii) a score of 2 (vegetative) or 3 (severe disability) on the Glasgow Outcome Scale, according to a test administered more than six months after the accident by a person trained for that purpose;
(e) an impairment or combination of impairments that results in 55 per cent or more impairment of the whole person; or
(f) an impairment that results in a class 4 impairment (marked impairment) or class 5 impairment (extreme impairment) due to mental or behavioural disorder.
The legal definition of catastrophic impairment is quite rigid, and only applies to significant cases of physical and/or mental disability after an accident.
However, the benefits that can be received are also significantly higher. For example, compared to the general maximum cap of $50,000 for medical treatment, those with catastrophic impairment receive a maximum cap of $1,000,000. Furthermore non-catastrophic medical rehabilitation benefits are only available for 10 years, while catastrophic benefits are available for the injured person’s entire life. This is in large part due to the fact that rehabilitation for catastrophic impairments will take significantly longer and be far more involved than less extensive and serious injuries. For the same reason, attendant care is significantly higher as well.
Due to the potential for high reimbursement payouts, insurance companies will do everything in their power to ensure that injuries are not deemed to be on the level of catastrophic impairment. As a result, having an experienced and dedicated legal team behind you is vitally important to ensure that all of your medical needs are covered.