Catastrophic Injury

Any injury that a person suffers will impact their life to some degree. Minor injuries usually require limited medical treatment and some additional rest and time to allow your body to heal. More severe injuries often call for substantial medical intervention and have a recovery trajectory that is less certain. But what about injuries so severe that they are deemed catastrophic?

Catastrophic injuries cause permanent disability that necessitate a lifetime of attendant care, special treatments or other significant interventions. There are a range of injuries that are considered catastrophic and different medical-legal criteria are used to determine if a person qualifies. However, an insurance company ultimately decides whether an insured’s impairment will be considered catastrophic - and sometimes they reject deserving claims. 

If you or a loved one has sustained a serious injury and you want to ensure that your right to receive the compensation you deserve is protected, consider speaking with a catastrophic injury lawyer at Gluckstein Lawyers.

What injuries are considered catastrophic?

Many catastrophic injuries result from motor vehicle accidents. Ontario’s Statutory Accident Benefits Schedule, also known as ("SABS"), will automatically consider a person to have suffered catastrophic impairment if he or she has sustained a traumatic brain injury and is:

Accepted for admission on an in-patient basis at a public hospital named in a Superintendent Guideline with positive findings on a computerized axial tomography (CAT) scan, a magnetic resonance imaging (MRI), or any other medically-recognized brain diagnostic technology indicating intracranial pathology.

Accepted for admission on an in-patient basis to a program of neurological rehabilitation in a pediatric rehabilitation facility that is a member of the Ontario Association of Children’s Rehabilitation Services.

Other injuries may also be deemed catastrophic; however, they must be confirmed by medical assessments based on specific diagnostic guidelines. These injuries include:

• Paraplegia or tetraplegia.
• Severe impairment of ambulatory mobility or use of an arm, or amputation.
• Loss of vision of both eyes.
• Traumatic brain injury (applicant 18 years of age or older at the time of the accident).
• Traumatic brain injury (applicant under 18 years of age at the time of the accident).
• Physical impairment or combination of physical impairment which results in 55% or more of the whole person. 
• Mental or behavioural impairment, excluding traumatic brain injury, combined with a physical impairment which results in 55 percent or more impairment of the whole person. 
• A Class 4 impairment (marked impairment) in three or more areas of function that precludes useful functioning or a Class 5 impairment (extreme impairment) in one or more areas of functioning, due to mental or behavioural disorder.
• Certain impairment of individuals who were injured when under the age of 18, when developmental complications are considered through analogous tests.

An experienced catastrophic injury lawyer can help.

SABS provides guidelines for compensation based on the severity of the injury sustained in a motor vehicle accident.

Minor injuries, generally including whiplash associated disorders, strains, sprains and subluxations (vertebrae slightly out of alignment) are eligible to receive $3,500 for medical treatments for up to five years, and additional funds for income loss.

Non-catastrophic injuries (more severe than minor injuries but not catastrophic) can receive up to $65,000 for medical and attendant care for up to five years, and additional funds for income loss.

Catastrophic injuries are eligible for up to $1 million in medical and attendant care and more for income loss, caregivers and housekeeping over a lifetime.

As you can see, a catastrophic designation for your injury can make available a much higher level of SABS benefits to help you heal and rebuild your life.

In some cases, a catastrophic designation for your injury is obvious and undeniable. However, many serious injuries fall into what insurance companies call threshold cases. In these instances, determining whether a person qualifies for the higher benefit level that a catastrophic designation brings often comes down to the opinion of medical experts. 

Insurance providers will generally accept information from your medical practitioner, but for cases involving large sums of money, they will normally want you to see medical practitioners of their choice. That is their right; you cannot reasonably refuse to see the insurance provider’s assessors. But, must you accept their diagnostic opinion - especially if it limits your claim? Absolutely not.

As experienced catastrophic injury lawyers, the team at Gluckstein Lawyers has handled many cases where a second or third opinion by our network of independent medical experts has tipped the scales for threshold cases. We have helped our clients build strong cases against catastrophic injury claim denials and have ensured that every avenue to help access fair compensation is explored.

When to file a tort claim.

The monetary difference between SABS benefits for non-catastrophic injuries and catastrophic injuries is substantial. But, there is another factor that must be kept in mind when an insurer attempts to deny a rightful catastrophic injury designation: time.

If you have sustained a permanent, life-altering injury, your future medical or attendant care needs will not magically disappear after your non-catastrophic injury benefits have been exhausted (or the five-year time limit to access them expires). Often, people will need to draw on these kinds of benefits for many more years or the rest of their lives. If SABS alone won’t cover your current and future needs - and frequently it doesn’t - you may need to consider a tort claim for damages to supplement this compensation.

Tort claims can be filed when your injuries are partly or fully the result of someone’s negligent actions or inaction. Beyond motor vehicle accidents, incidents which can cause catastrophic injuries include:

• Medical malpractice.
• Birth injuries.
• Acts of violence.
• Premises liability accidents.
• Product liability accidents.

To be successful with a catastrophic injury tort claim, you must prove a person or persons violated a duty of care (responsibility for your safety) due to negligent actions or inaction. Proving liability in some of these cases can be challenging; by choosing catastrophic injury lawyers who have years of experience and a proven track record for results, you can be confident in your legal representation.

With our knowledge of the laws governing catastrophic injury claims and our ability to draw on extensive legal resources, Gluckstein Lawyers can fight for maximum damages on your behalf. Our team can also help ensure that all notice requirements are filed in a timely manner if a government entity bears liability.

Similar to the caps on SABS benefits, Ontario law imposes certain tort damage caps that may limit a catastrophically injured person’s recovery. For example, there is a limit on damages for pain and suffering. Damages for income loss and the future cost of care (medical and related expenses) do not have a cap, however. A Gluckstein catastrophic injury lawyer can offer insight on what claims you can advance for pain and suffering, income loss, recovery of medical, rehabilitative, and attendant care following a catastrophic accident.

Gluckstein’s commitment to our catastrophic injury clients.

When Gluckstein Lawyers litigate or negotiate catastrophic injury claims with insurance providers we are interested in more than just how much compensation we can help you receive. We want to ensure that the compensation you receive will work best for you and your loved ones as you begin a new chapter and work towards achieving the best quality of life possible.

This commitment not only means building cases for catastrophic injury designations when possible, but helping you plan for life after the lawsuit. In our experience, when a significant negotiated settlement or court-ordered award for damages is provided for a catastrophic injury, deciding how to manage it requires well-informed thought and careful consideration. 

Our legal team will explain the pros and cons of receiving a large lump sum payment or something called a structured settlement. While a one-time payment can be invested and drawn upon as you need it, these funds can also be inadvertently exhausted before your needs are fully met. A structured settlement managed by an independent organization provides reliable pay out of funds in a planned way over many years based on anticipated needs.

Ensuring you and your loved ones are respected, supported and cared for during and after the life of a legal case is part of Gluckstein Lawyers’ commitment to full circle care. When you or a loved one has been dealt a life-shattering blow by sustaining a catastrophic injury, you don’t have to face the future alone. Let our team of personal injury lawyers in Toronto, Ottawa, Niagara, and Barrie be your compassionate advocates for care, and your fierce defenders of your right to fair compensation.