Sarnia Catastrophic Injury Lawyer

Anyone who is injured in an Ontario motor vehicle collision should be able to submit an insurance claim for accident benefits. No-fault accidents benefits should be available to all parties who were injured as the result of an accident, including motor vehicle operators, their passengers, cyclists, and pedestrians.

Receiving accident benefits can be a crucial lifeline for injured car accident survivors struggling to live through an immensely difficult and challenging experience. The accident benefits available to injured car accident survivors are based on the severity of the injuries they have sustained. For instance, all basic auto insurance plans must include the following coverage:

• Minor injuries: $3,500 in medical and rehabilitation benefits
• Non-minor, non-catastrophic injuries: $65,000 for the combined total costs of medical, rehabilitation, and attendant care benefits for 5 years
• Catastrophic injuries: $1 million in combined medical, rehabilitation, and attendant care benefits for life

The benefits available to catastrophically impaired accident survivors are meant to provide them with ongoing support to help them manage their injuries and their associated costs throughout their lifetime. However, insurers may find reasons or excuses to deny or dispute the claims of catastrophically impaired survivors of motor vehicle collisions. One of the most common methods to withhold proper coverage is by asserting that the claimant’s injuries do not meet the threshold of catastrophic impairment.

In addition to legislating the specific amounts of coverage that should be available to injured accident victims, the province of Ontario’s Statutory Accident Benefits Schedule (SABS) provides a legal definition for the phrase “catastrophic impairment.” By standardizing this definition, the SABS attempts to clarify which injured policyholders should be entitled to the higher tier of accident benefits.

According to the SABS, a claimant could meet the definition of catastrophic impairment if their motor vehicle accident resulted in at least one of the following:

• Paraplegia or Tetraplegia
• Severe impairment of ambulatory mobility or use of an arm; or Amputation
• Loss of Vision of Both Eyes
• Traumatic Brain Injury (TBI) meeting the Glasgow Outcome Scale-Extended (GOS-E) criteria
• Physical Impairment or Combination of Physical Impairments (which results in 55% or more of whole person)
• Mental or Behavioural Impairment (excluding Traumatic Brain Injury) Combined with a Physical Impairment (which results in 55% or more impairment of the whole person)
• Marked impairment in three or more areas of function that precludes useful functioning; or an Extreme impairment in one or more areas of functioning due to mental or behavioural disorder

When evaluating accident benefits claims, insurers should review the applicant’s OCF-19 form. This application for a determination for the designation of “catastrophic impairment” must be completed by the claimant’s physician or a healthcare expert qualified to speak about the injuries their patient sustained. However, just because a qualified medical professional provides their opinion and prognosis does not mean an insurance company has to listen to their appeal.

If an insurer disputes the claim of a catastrophically impaired accident survivor, the injured party may be forced to undergo independent medical examinations conducted by other physicians and healthcare providers. Insurers may use findings from these evaluations to deny a policyholder’s accident benefits claim. They may also try offering claimants far less coverage than what they should be owed, threatening to engage in daunting, drawn-out dispute resolution processes in order to pressure the applicant to accept a lower amount.

If you have found yourself in this unfortunate set of circumstances, consider taking advantage of a free initial consultation with our Sarnia catastrophic injury lawyers. Do not hesitate to contact us today.

Call Our Catastrophic Injury Lawyers Serving Sarnia

Our Sarnia catastrophic injury lawyers pride ourselves in standing up for the rights of injured accident survivors. No one should be forced to try taking on a large insurance company on their own. If you need our help to fight for your best interests, contact us today and book a free initial consultation with our catastrophic injury lawyers serving Sarnia.