Understanding Catastrophic Impairment Diagnosis and the Impact in Ontario Personal Injury Cases

September 19, 2024, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Catastrophic impairment is a term that carries significant weight in Ontario's personal injury law. At Deutschmann Law, we recognize the profound impact these severe injuries can have on individuals and their families. Understanding what constitutes catastrophic impairment and its legal implications is crucial for those navigating serious injury claims in Ontario.

Defining Catastrophic Impairment

In Ontario, catastrophic impairment is a legal designation within the Statutory Accident Benefits Schedule (SABS). This designation is reserved for the most severe injuries resulting from motor vehicle accidents. The definition has evolved over time, with the most recent changes implemented in June 2016.

Current Criteria for Catastrophic Impairment

As of 2024, the following conditions may qualify as catastrophic impairment:

1. Paraplegia or tetraplegia.
2. Severe impairment of ambulatory mobility or use of an arm
3. Loss of vision of both eyes
4. Traumatic brain injury meeting specific criteria
5. Physical impairment or combination of physical impairments resulting in 55% or more impairment of the whole person6. Mental or behavioural impairment, excluding traumatic brain injury, combined with a physical impairment resulting in 55% or more impairment of the whole person
7. Marked impairment in three or more areas of function that precludes useful functioning, due to mental or behavioural disorder

Importance of the Catastrophic Impairment Designation

The catastrophic impairment designation is crucial because it significantly increases the benefits available to the injured person. These enhanced benefits include:

• Medical and Rehabilitation Benefits: Increased from $65,000 to $1 million
• Attendant Care Benefits: Increased from $36,000 to $1 million
• Potential access to case management services
• Housekeeping and Home Maintenance: $100 per week, not available for non-catastrophic claims

The Assessment Process

Determining catastrophic impairment involves a comprehensive assessment by medical professionals. This typically includes:

• Detailed medical examinations
• Functional capacity evaluations
• Neuropsychological assessments (for brain injuries)
• Review of medical records and diagnostic imaging

It's important to note that the assessment process can be complex and time-consuming. At Deutschmann Law, we work closely with medical experts to ensure our clients receive thorough and accurate assessments.

Challenges in Catastrophic Impairment Cases

Securing a catastrophic impairment designation can be challenging:

1. Insurers May Dispute the Designation: Insurance companies often contest catastrophic impairment claims due to the significant increase in benefits.

2. Evolving Nature of Injuries: Some injuries, particularly brain injuries, may not immediately meet the catastrophic threshold but may worsen over time.

3. Complexity of Assessments: The multifaceted nature of catastrophic injuries often requires input from various medical specialists, making the assessment process complex.

4. Changes in Legislation: Staying abreast of legislative changes is crucial, as definitions and criteria can shift.

The Role of Legal Representation

Having experienced legal representation is crucial in catastrophic impairment cases. At Deutschmann Law, we:

• Guide clients through the complex assessment process
• Work with medical experts to build strong cases
• Advocate for clients' rights against insurance companies
• Ensure all potential benefits are explored and secured

Long-Term Implications of Catastrophic Impairment

A catastrophic impairment designation acknowledges the long-term, life-altering nature of these injuries. Beyond the immediate increase in benefits, it recognizes the need for ongoing support in areas such as:

• Long-term medical care and rehabilitation
• Home modifications for accessibility
• Vocational rehabilitation or retraining
• Psychological support for both the injured person and their family

Case Study: The Impact of Proper Representation

Consider a recent case where our client suffered a severe brain injury in a car accident. Initially, the insurer denied the catastrophic impairment designation. Through careful documentation, expert testimony, and persistent advocacy, we successfully secured the designation, dramatically increasing the available benefits and support for our client's long-term care needs.

Looking Ahead: The Future of Catastrophic Impairment Law in Ontario

As medical understanding of severe injuries evolves, so too may the legal definitions and criteria for catastrophic impairment. At Deutschmann Law, we stay at the forefront of these developments to ensure our clients receive the most current and effective representation.

Dealing with a catastrophic injury is an overwhelming experience. If you or a loved one has suffered a severe injury in Ontario, it's crucial to seek experienced legal counsel. At Deutschmann Law, we're committed to guiding you through the complex process of securing the catastrophic impairment designation and ensuring you receive the full range of benefits you're entitled to. Our goal is to provide the support and advocacy you need to focus on your recovery and adaptation to life after a catastrophic injury.

About Deutschmann Law

Deutschmann Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.deutschmannlaw.com or call us at 1-519-742-7774.

It is important that you review your accident benefit file with one of our experienced personal injury / car accident lawyers to ensure that you obtain access to all your benefits which include, but are limited to, things like physiotherapy, income replacement benefits, vocational retraining and home modifications.