Windsor Catastrophic Injury Lawyer

Catastrophic injuries can lead to a lifetime of medical expenses, lost wages, ongoing pain and suffering, and a reduced overall quality of life. Survivors of motor vehicle accidents who have sustained catastrophic impairments often find themselves struggling to keep up with the ongoing, expensive costs of necessary treatments and services over the course of their lives, leading to a diminished overall quality of life.

In the province of Ontario, any party who has sustained injuries in a motor vehicle accident– regardless of their level of culpability for the collision– should be entitled to no-fault accident benefits. The province’s Statutory Accident Benefits Schedule (SABS) determines the mandatory minimum amount of accident benefits that must be included in all auto insurance policies throughout Ontario. The amounts of accident benefits available to injured motor vehicle collision survivors are determined by the severity of the injuries they sustained as a result of these traumatic events.

Ontario’s SABS also provides a legal definition for the term “catastrophic impairment” in order to determine which accident survivors are entitled to higher levels of insurance coverage. In accordance with this definition, a motor vehicle accident survivor could be considered catastrophically impaired if their collision resulted in at least one of the following conditions:

• 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

Whereas accident survivors who have suffered minor injuries are entitled to $3,500 in medical and rehabilitation benefits and those who have suffered non-minor, non-catastrophic injuries are entitled to $65,000 over 5 years for the combined total costs of medical, rehabilitation, and attendant care benefits, catastrophically injured motor vehicle accident victims are eligible for significantly higher amounts of benefits. Although individual motorists may purchase additional coverage, all basic auto insurance plans in Ontario include provisions for up to $1 million for life in combined medical, rehabilitation, and attendant care benefits for accident victims who sustained catastrophic injuries.

The process of submitting a claim for accident benefits can be complex and time-consuming. There are many factors considered by insurers when determining whether a claimant is eligible for higher amounts of accident benefits.

In situations wherein accident victims sustained catastrophic injuries, the medical opinion of the claimant’s physician is required to complete and submit an OCF-19 form in order to apply for a determination of catastrophic impairment. Once the application is submitted, the insurance provider will review it and make a decision on the amount of benefits to which the accident survivor is entitled. If an insurance provider disputes whether an applicant’s injuries meet the definition of catastrophic impairment, they may request that the applicant undergo an independent medical examination.

Insurance providers may not always act in the best interests of accident survivors. They may find reasons to deny or delay benefits, dispute the severity of injuries, or offer low settlement amounts to catastrophically impaired accident survivors.

If your claim for accident benefits was denied or disputed by your insurance provider, consider taking advantage of a free initial consultation with our Windsor catastrophic injury lawyers. We are standing by to discuss your case. Contact us today to speak with us about your situation.

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Our catastrophic injury lawyers serving Windsor are passionate about helping injured members of the local community get the compensation they deserve. To learn more about options that might be available to you, contact us today.