If you've been injured in a car accident in Ontario, you may be entitled to accident benefits through your insurance company. These benefits help cover medical expenses, income replacement, and rehabilitation costs. Since Ontario operates on a ‘no-fault’ system, you can claim accident benefits even if you were at fault for the accident.
One of the most important aspects of accident benefits is the classification of your injuries. The insurance adjuster handling your claim will place you in one of three categories:
- Minor Injury Guideline (for less severe injuries)
- Regular Injury Guideline (for more serious injuries that don’t qualify as catastrophic)
- Catastrophic Impairment (for the most severe, life-altering injuries)
Being classified as having a catastrophic impairment significantly increases the level of benefits you can receive. If your injuries are deemed catastrophic, you are eligible for up to $1,000,000 in medical, rehabilitation, and attendant care benefits—a much higher limit than those in the other two categories. These benefits last a lifetime or until the financial cap is reached.
Additionally, people with catastrophic injuries are often eligible for income replacement benefits until retirement and beyond (at a reduced rate) since their injuries typically prevent them from returning to work.
When an insurer classifies an injury as catastrophic, it closely monitors the “burn rate” of the victim’s benefits. If a person requires ongoing medical care, rehabilitation, and support services, the insurer may offer a lump sum settlement rather than continuing long-term payments.
If you sue an at-fault driver, your ability to recover compensation depends on the threshold test under Ontario’s Insurance Act. To qualify for damages, you must prove that you suffered a permanent serious disfigurement or a permanent serious impairment of an important physical, mental, or psychological function.
Most individuals with catastrophic impairments meet this test, allowing them to claim compensation for pain and suffering and healthcare expenses. Additionally, Ontario law imposes a $46,053.20 deductible on pain and suffering awards under $147,889.59. However, accident victims with catastrophic injuries will likely exceed this amount, meaning the deductible would not apply to their case.
Ontario’s Statutory Accident Benefits Schedule (the “SABS”) outlines eight criteria for determining catastrophic impairment. These include, but are not limited to:
- Total loss of vision in both eyes
- Paraplegia or quadriplegia (loss of use of limbs)
- Amputation of an arm or leg
- Severe traumatic brain injuries
- Severe physical impairments affecting daily life
- A combination of mental and physical impairments
- Severe mental disorders
Each case is unique, and medical evaluations are key in determining whether an injury
meets the catastrophic threshold.
If you or a loved one has suffered a serious injury in a car accident, you don’t have to navigate this complex process alone. At HURT911 Injury Law, we have the experience and dedication to fight for your deserved compensation. Contact us today at 1-855-HURT911 (487-8911) or complete our secure online form for a free, no-obligation consultation.
This blog post is for informational purposes only and does not constitute legal advice. Every case is unique; legal outcomes depend on specific facts and circumstances. If you require legal assistance, please contact a qualified personal injury lawyer.