In Ontario, individuals injured in motor vehicle accidents may be eligible for accident benefits, which can be pivotal for recovery, rehabilitation, and long-term care. The process for determining eligibility for these benefits, especially for catastrophic injuries, is complex and often contentious. A recent court decision has brought renewed attention to the standards and procedures for catastrophic determination, impacting both personal injury law and claimants seeking fair access to accident benefits.

Catastrophic Injury Determination: What It Means

“Catastrophic injury” is a term with significant legal implications in Ontario. When an injury is deemed catastrophic, the claimant becomes eligible for higher limits on medical, rehabilitation, and attendant care benefits under the Statutory Accident Benefits Schedule (SABS). Catastrophic injury determinations include severe physical injuries, traumatic brain injuries, and mental or behavioral impairments.

In 2016, Ontario updated the definitions and criteria for catastrophic impairment under the SABS, adding layers to the assessment process. Many of these standards remain a source of debate and, in some cases, litigation. Legal professionals and medical experts must apply the criteria carefully, and the courts often step in to clarify complex issues in catastrophic injury determinations..

Recent Court Decision: Key Takeaways

In a recent Ontario Superior Court case, the court reviewed the denial of catastrophic impairment status for a claimant who suffered multiple, life-altering injuries in a car accident. The claimant’s legal team argued that the injuries met the threshold for catastrophic impairment under SABS, entitling their client to increased benefits essential for their long-term care. Here are some of the pivotal points the court addressed:

• Interplay of Physical and Psychological Impairments: The claimant’s injuries included not only physical trauma but also significant psychological issues resulting from the accident. The court recognized that severe psychological conditions could be as debilitating as physical impairments and, therefore, equally relevant in determining catastrophic impairment status. This ruling emphasized the importance of assessing the holistic impact of injuries.
• Threshold for “Whole Person Impairment”: The court reviewed the whole person impairment (WPI) rating, a metric used to evaluate the overall severity of injuries. The claimant’s legal team argued that the cumulative effect of physical and psychological injuries met the 55% WPI threshold for catastrophic impairment. The court’s findings reinforced that the WPI rating should not be
  limited to isolated injuries but should consider the cumulative effect on the claimant’s daily life and ability to function.
• Expert Testimony in Catastrophic Determination: Another focal point of this case was the role of expert medical assessments in determining catastrophic impairment. The court stressed that insurers should not dismiss credible medical opinions that support catastrophic determinations. In this case, expert testimony was instrumental in demonstrating the extent of the claimant’s impairments and their impact on quality of life.
• Insurer Obligations: The court criticized the insurer’s reluctance to fully recognize the claimant’s impairments, signaling a need for insurers to approach catastrophic determination claims with fairness and due consideration. Insurers must provide clear reasoning if they decide to deny a claim and should ensure their assessments are thorough and aligned with the SABS criteria

Implications of the Decision

This decision has set a precedent that reinforces the comprehensive approach needed in catastrophic injury claims. Insurers are reminded of their duty to fairly assess both physical and psychological impairments, and claimants are empowered to seek fair compensation without undue limitation. Personal injury lawyers can use this ruling to support their clients’ cases when catastrophic impairment claims are denied
without a reasonable basis.

Seeking Legal Assistance for Catastrophic Injury Claims

The complex nature of catastrophic injury determinations means that navigating these claims can be overwhelming. Legal representation becomes essential, especially when insurers challenge the validity of catastrophic impairment claims. Singh Barristers is committed to advocating for claimants who need access to the benefits essential for their recovery. Our team has the expertise to present compelling cases for catastrophic determination, ensuring our clients receive the benefits they deserve.

If you or a loved one has suffered a catastrophic injury in an accident, contact Singh Barristers to discuss your options. We provide compassionate and dedicated legal support to help you secure the accident benefits necessary for your journey to recovery.