Catastrophic injuries represent some of the most severe personal injuries and include conditions such as spinal cord injuries, traumatic brain injuries, amputations, loss of vision, and severe orthopedic injuries. Victims of such injuries who are involved in automobile accidents can access additional benefits known as Statutory Accident Benefits (SABS). Understanding your rights and the benefits available is crucial for ensuring you receive the support you need.
What is a Catastrophic Impairment?
The term “catastrophic impairment” is defined by the Statutory Accident Benefits Schedule (SABS) and involves several criteria. A person may be classified as catastrophically impaired if they meet any of the following conditions:
Here are the eight criteria for determining catastrophic impairment as defined by the Statutory Accident Benefits Schedule (SABS):
- Paraplegia or Tetraplegia: Complete loss of function in the lower body (paraplegia) or the upper and lower body (tetraplegia).
- Severe Impairment of Mobility or Limbs: Significant loss of mobility use of an arm or leg or the amputation of a limb.
- Loss of Vision: Complete loss of vision in both eyes.
- Traumatic Brain Injury (Age 18 and Over): For individuals aged 18 and older, a traumatic brain injury must be verified by medical imaging. Additionally, the Glasgow Outcome Scale assessment should show that the injury results in:
- A. A vegetative state for at least one month following the accident,
- B. Severe disability (upper or lower) lasting six months or more after the accident or
- C. Moderate disability (lower) lasting one year or more after the accident.
- Traumatic Brain Injury (Under Age 18): For those under 18, a traumatic brain injury must be confirmed by medical imaging, accompanied by either hospital admission or severe neurological impairment.
- Significant Physical Impairment: A physical impairment or a combination of impairments that results in 55% or more overall impairment of the whole person, as per the American Medical Association’s Guides to the Evaluation of Permanent Impairment (4th edition, 1993).
- Mental or Behavioral Impairment: A mental or behavioural impairment, excluding traumatic brain injury, assessed according to the American Medical Association’s Guides (6th edition, 2008). When combined with a physical impairment, the total impairment must be 55% or more of the whole person.
- Class 4 or 5 Impairment: An impairment that, according to the American Medical Association’s Guides (4th edition, 1993), results in a class 4 impairment (marked impairment) in three or more functional areas or a class 5 impairment (extreme impairment) in one or more functional areas due to a mental or behavioural disorder, which severely limits useful functioning.
Given the complexity of these criteria, having a knowledgeable personal injury lawyer is essential to navigate the process and secure the maximum benefits.
Catastrophic Injury and Compensation
The term “catastrophic” is not just a description but also a legal classification with significant implications for compensation. If an injury results from an automobile accident, victims are entitled to no-fault accident benefits. These benefits vary by severity:
- Minor Injury Guideline (MIG): Covers up to $3,500 for medical and rehabilitation needs.
- Non-Catastrophic Impairment (non-CAT): Provides up to $65,000 for medical, rehabilitation, and attendant care needs.
- Catastrophic Impairment (CAT): Offers up to $1,000,000 for medical, rehabilitation, and attendant care expenses.
How We Can Help
Navigating catastrophic injury claims requires expertise, as insurance companies often resist acknowledging catastrophic impairments to limit their financial exposure. At Asadullah Law, our personal injury lawyers are well-versed in handling such complex cases.
Criteria for Accessing Accident Benefits
The process of accessing accident benefits is intricate, with different criteria for various benefits, such as medical rehabilitation or income replacement. Understanding these criteria is vital for obtaining the appropriate compensation.
Significance of Catastrophic Impairment Designation
Being designated as catastrophically impaired has significant implications. It entitles individuals to the highest accident benefits, up to $1,000,000, compared to $65,000 for non-catastrophic impairments. Additionally, in a negligence claim, catastrophically impaired individuals can seek compensation for future care costs, ensuring long-term financial support for their care needs. In contrast, those not classified as catastrophic are limited to claims for loss of household and handyman capacity.
Practical Difficulties in Catastrophic Impairment Cases
The financial stakes are high, leading insurance companies to vigorously challenge catastrophic impairment claims. They may choose specific doctors or conduct examinations to contest the impairment designation. Our lawyers are equipped to handle these challenges, working with top specialists to support your claim.
Insurer Examinations
Section 44 of the SABS allows insurers to require medical examinations to assess entitlement to benefits. However, insurers must follow specific rules regarding the qualifications of examiners and scheduling. Our team ensures that insurers comply with these regulations and that your case is not prejudiced.
Choosing the Right Case Manager
case manager is crucial in coordinating your recovery and ensuring effective treatment. While you have the right to choose your case manager, insurance companies sometimes appoint one before you can select. We help replace such managers with trusted professionals focused solely on your needs.
Going Beyond the Law
Dealing with catastrophic injuries is not only a legal challenge but also an emotional and practical one. At Asadullah Law, we support you by assigning dedicated accident benefits coordinators, keeping you informed, ensuring top-quality health professionals are involved, and striving for a fair and swift settlement.
If you or a loved one has been seriously injured due to the negligence of another party and you have questions about pursuing legal action, please contact personal injury lawyer Mohammad Asadullah at 905-268-0046 or mohammad@asadlaw.ca