We generally use the term ‘catastrophic injury’ to apply to severe and life-altering injuries, such as blindness or a spinal injury that results in paraplegia. However, ‘catastrophic impairment’ has a very specific meaning with respect to accident benefits pursuant to Ontario’s Insurance Act. Catastrophic impairment refers to the most serious category of injuries that may be sustained by a motor vehicle accident victim, and is based on eight criteria defined under Ontario’s statutory accident benefits schedule (SABS).
If someone is injured in a motor vehicle accident, they can claim ‘no fault’ accident benefits from their vehicle insurer or from the insurer of a driver involved in the accident. When you claim accident benefits, the amount of maximum benefits to which you’re entitled depends on the severity of your injury. The three main injury categories, in order of increasing severity of injury, are: minor injury, non-minor injury and catastrophic impairment.
If you were injured in a motor vehicle accident or are wondering whether you have sufficient vehicle insurance, it’s important to learn how the catastrophic impairment designation may affect your access to owed benefits. You may purchase additional coverage under your vehicle insurance policy, which would provide a higher level of benefits in the event you are injured.
In June 1st, 2016, the Ontario government reduced the amount of maximum benefits for medical, rehabilitation and attendant care expenses to $1 million (previously $2 million, combined). The government also changed some of the criteria for ‘catastrophic impairment’, most notably, by adding a new mental behaviour criteria and replacing the Glasgow Coma Scale (GCS) with the Glasgow Outcome Scale, used in assessing brain impairment.
This change in the guidelines for catastrophic impairment has impacted many Ontario accident victims, the likely first of whom was Adam Bari, a 34-year-old father. On June 1st, 2016, Mr. Bari was severely injured in a motorcycle accident. The driver of the vehicle that caused the collision was subsequently charged with careless driving.
After the accident, Mr. Bari was in a coma for approximately one month, and his injuries included basal skull fracture, traumatic brain injury, internal organ damage and multiple fractures to his pelvis, right arm, leg and hand.
If Mr. Bari’s accident had occurred one day earlier and before the change to SABS, he would have been met the definition of catastrophic impairment, based on the GCS. As a result, Mr. Bari would have been entitled to up to $2 Million in accident benefits. Unfortunately, under the new guidelines, Mr. Bari was entitled to only $65,000 in benefits (for medical, rehabilitation and attendant care expenses) because he did not meet the new criteria of catastrophic impairment. When hospital staff initially evaluated his functionality, he scored three on the GCS, which is the most severe result and would have qualified him for maximum benefits. However, under the new system, patients are re-assessed at one month, six months and nine months, using imaging technology such as CT scans and MRIs, and because Mr. Bari’s condition improved at these checkpoints -- his GCS score rose to eight – he did not meet the new criteria and was eligible only for benefits under the non-minor injury classification.
The motorcycle accident and Mr. Bari’s injuries had a devastating impact on his family. A CBC News article reported that the Bari family was concerned that the $65,000 in received accident benefits will not last long. The injured man requires a personal support worker as well as physiotherapy, and Mr. Bari’s doctor was uncertain whether he will be able to drive or return to his previous job as a tool-and-die worker. The accident victim’s wife stated that only their mortgage insurance was preventing the family from losing their house.
In addition to statutory accident benefits under a driver’s vehicle insurance, anyone injured in a motor vehicle accident is entitled to claim damages against the negligent driver who caused the accident. Accident victims may avail themselves of both options for compensation, which is fortunate for accident victims and their families for whom accident benefits are often insufficient to cover real losses associated with an injury. The Bari family is planning to sue the driver for damages for rehabilitation expenses and other losses.
If you or a loved one were injured in a motor vehicle accident, call an experienced motor vehicle accident lawyer at Kotak Personal Injury Law to find out about your legal options for compensation.