If you're injured in a car accident, your insurer will place you into one of three Statutory Accident Benefit categories, based on the severity of your injury. The category you're placed in determines the amount of money you can receive from medical/rehabilitative benefits. Your category also determines whether attendant care benefits are available to you.
Why are we telling you all of this?
Because more often than not, insurance companies will initially place injured claimants in a lower category than what they are entitled to be in. As you will see below, there are major discrepancies between the benefits available in each category.
This is why it is important that claimants have a lawyer who can advocate on their behalf and ensure that they are placed in the category appropriate to their degree of injury. When we are retained, it is often our immediate focus to have our client moved to a higher category of benefits.
How Statutory Accident Benefits work
In Ontario, it's mandatory for every motor vehicle insurance policy to include an endorsement called the Statutory Accident Benefits Schedule1 (the "SABS"). The SABS is a form of no-fault insurance that provides certain benefits to anyone injured in a motor vehicle accident. Among other things, these benefits are intended to help pay for medical, rehabilitation and attendant care expenses arising from an accident.
Categories of impairment:
1) Minor injuries: The SABS defines a minor injury as "one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associate sequelae to such an injury." If your injuries are deemed by your insurance company to be minor in nature, you are provided with benefits pursuant to the Minor Injury Guideline (the "MIG"). The MIG provides a maximum of $3,500 for medical/rehabilitation benefits. No attendant care benefits are available for minor injuries.
2) Non-catastrophic ("Non-CAT") impairments: This category encompasses injuries that fall outside the MIG definition but are less severe than catastrophic. Examples of non-catastrophic impairments include fractures, chronic pain and psychological impairments. A combined limit of $65,000 for medical/rehabilitation benefits and attendant care benefits is available for such injuries.
3) Catastrophic ("CAT") impairments: This category is reserved for injuries that result in a permanent and serious impairment that significantly impacts the person's ability to carry out their daily activities. Examples of catastrophic impairments include severe brain injury, blindness in both eyes, amputation, paraplegia and quadriplegia. The SABS provides a number of ways in which a person can meet the definition of catastrophic impairment. This category provides a combined limit of $1,000,000 for medical/rehabilitation benefits and attendant care benefits.
Moving from MIG to Non-CAT:
Until an insurance company has received detailed medical evidence, they may keep the claimant in the MIG even if their reported injuries are not minor. This is why it is important for an injured person to seek medical attention and follow up with any recommended treatments or therapies. The medical records that result from these attendances can serve as evidence to support removal from the MIG. In certain circumstances, pre-existing conditions such as depression or prior injury can result in a person being moved into the "non-catastrophic" category. A lawyer can help to determine what underlying conditions or pre-existing injuries are relevant and can provide the necessary documentary evidence to the insurance company.
Moving from Non-CAT to CAT:
There are a number of ways in which a person can be deemed catastrophically impaired, and many of those ways involve a detailed analysis beyond just a review of the diagnosed injuries. For example, a person can be catastrophically impaired if they have a severe mental or behavioural disorder as a result of the accident and that disorder impairs their function in a specific way.
Through Siskinds' years of experience in personal injury law, we have come to understand the many ways in which our clients may fit into the definition of catastrophic impairment. Particularly with the subjective nature of brain injuries, proving that a claimant is catastrophically impaired requires a substantial degree of medical and legal evidence. We know what questions to ask, what specialists to recommend and how to apply the statutory tests in their broadest interpretation.
Speak to a lawyer
Being moved into a higher category of benefits significantly increases your available medical, rehabilitation and attendant care benefits. These benefits provide you with immediate funding for treatment. As such, it is critical to your recovery that you act quickly to retain a lawyer who can assist in this process.
1. O. Reg. 34/10 under Insurance Act, R.S.O. 1990, c. I.8.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.