What makes an injury “catastrophic”?

A term that is often heard in the context of auto accidents, insurance, and lawsuits is “catastrophic injury”. As you’d imagine, a catastrophic injury is very serious, but there’s an actual definition in Ontario legislation, found in section 3 (2) of the Statutory Accident Benefits Schedule – Effective September 1, 2010, which is a regulation under the Insurance Act. There are also other related regulations applicable to accidents that happened during earlier time frames. And unfortunately, the Ontario government is narrowing the definition of “catastrophic injury” and reducing the benefit limits for accidents that occur on or after June 1, 2016.

This definition is used to determine a person’s eligibility for Statutory Accident Benefits (SABS) or “no fault benefits” – in other words, the coverage extended to all insured people injured in an auto accident (regardless of fault). This coverage helps pay for things like medical treatment, rehab, housekeeping assistance and caregiver expenses.

You can read the full text of the section for all the fine print here, but here’s a general summary of what constitutes a “catastrophic impairment” at present:

  • paraplegia or quadriplegia;
  • the amputation of an arm or leg or another impairment causing the total and permanent loss of use of an arm or a leg;
  • the total loss of vision in both eyes;
  • brain damage that scores certain numbers on the Glasgow Coma Scale or Glasgow Outcome Scale
  • certain impairments or combinations of impairments that result in 55% or more impairment of the whole person
  • impairments that result in market or extreme impairment due to mental of physical disorders.

Anyone whose insurance coverage isn’t sufficient to meet their medical needs should work with a lawyer to negotiate with the insurance company or commence legal action to obtain the compensation they require.