How do I know if I have sustained a catastrophic impairment following my motor vehicle accident?

In Ontario, the definition of catastrophic impairment for motor vehicle accident benefits claims is outlined in the Statutory Accident Benefits Schedule (SABS).  This designation entitles an injured parties enhanced accident benefits under the policy of insurance.

To be classified as catastrophically impaired, an individual must meet at least one of the following criteria:

1. Paraplegia or Tetraplegia

2. Severe impairment of ambulatory mobility or use of an arm, or amputation

3. Loss of vision in both eyes

4. Traumatic brain injury meeting specific Glasgow Outcome Scale criteria

5. Physical impairment or a combination of physical impairments resulting in 55% or more impairment of the whole person

6. Mental or behavioural impairment combined with a physical impairment (excluding traumatic brain injury) leading to 55% or more impairment of the whole person

7. Marked impairment in three or more areas of function that prevent useful functioning, or an extreme impairment in one or more areas of functioning due to a mental or behavioural disorder

The process of determining catastrophic impairment can vary in length, depending on the complexity of the injuries and the time required for medical assessments.  In some cases, the law states that an insured may have to wait at least 2 years before undergoing assessments.

If there is a dispute between you and the insurer regarding the findings on such an impairment, then the matter can be taken to the License Appeal Tribunal (LAT) for resolution.

Determining whether you have sustained a catastrophic impairment from a motor vehicle accident in Ontario involves several key steps:

1. Medical Assessment:

• Undergo a comprehensive medical assessment by qualified healthcare providers, such as neurologists, orthopedic surgeons, or psychiatrists. These assessments evaluate the nature and extent of your injuries and their impact on your daily functioning.
  
  2. Completion of the OCF-19 Form:

• Based on the medical assessments, your healthcare provider will complete the OCF-19 Form, also known as the “Application for Determination of Catastrophic Impairment.” This form provides detailed information about your injuries, impairments, and their impact on various aspects of life, such as mobility, self-care, and cognitive abilities.

  
  3. Submission to Insurance Company:

• Once the OCF-19 Form is completed, it is submitted to your insurance company for review. The insurance company will assess the information provided to determine if you meet the criteria for catastrophic impairment as outlined in the Statutory Accident Benefits Schedule (SABS).

  4. Decision and Communication:

• The insurance company will communicate its decision regarding your application for catastrophic impairment to you and your healthcare provider.

When you choose Porcelli D’Angela LLP, you are choosing unparalleled expertise, dedication, and personalized service.  What stands out is our years of experience which has established a proven track record of success, a deep understanding of the legal landscape, and a commitment to client satisfaction.  With our team of skilled legal professionals who specialize in personal injury law, Porcelli D’Angela LLP offers clients a wealth of knowledge, strategic thinking, and a relentless pursuit of justice, ensuing their legal matters are handled with the highest level of professionalism.

Call us at 647-490-944 for a free, no hassle consultation.  At Porcelli D’Angela LLP, you do not pay unless you recover money.

Disclaimer: The explanations and information provided here are for general informational purposes only and are not intended to be legal advice. Always consult with a qualified lawyer or legal professional for advice specific to your situation.