Accident benefits (ABs) coverage is available to all individuals who are injured as a result of the use or operation of an automobile. Individuals with severe impairments can be deemed catastrophically impaired under section 3.1 of the Statutory Accident Benefits schedule (SABs) if they meet the prescribed criteria. During the initial period following an incident, there will be a considerable amount of correspondence with the Accident Benefits insurance adjuster. While it is always important for an adjuster to be responsive, nowhere is this more important than the initial period following a catastrophic injury. Large treatment teams need to be coordinated and it is critical that funds are available to secure the treatment care that a catastrophically injured person will require.
Firstly, it is important to understand that the difference between catastrophic and non-catastrophic impairment is substantial. The caps for benefit amounts are vastly different, which is why catastrophic impairment claims can be complex. Furthermore, this is why an adjuster's determination regarding catastrophic impairment is so important for insureds with severe injuries. In serious cases, it is critical that an application for catastrophic impairment designation is made as soon as possible. It can be the difference between paying for the treatment they desperately need or not being able to afford it.
The current caps combine medical and rehabilitation benefits with attendant care benefits. The current limit under SABs is $65,000 for non-catastrophic victims and $1,000,000 for catastrophic victims. Furthermore, attendant care benefits are specifically capped at $3,000 per month for non-catastrophic claims and $6,000 per month for catastrophic claims. Catastrophic victims can receive benefits over the course of their lifetime, up to the legislated caps. Needless to say, the catastrophic determination can be crucial for insureds.
In assessing a file, it is important to be cognizant the types of injuries that are automatically deemed catastrophic under section 3.1(1) of SABs, including:
- Paraplegic
- Amputee
- Loss of vision in both eyes
- Certain traumatic brain injuries for adults
- Child with a brain injury who has been admitted to hospital
Most insurance adjusters understand the significant challenges faced by catastrophically injured individuals and execute their duties promptly and professionally. However, in instances of unreasonable delays or denial of benefits, it is critical to have a personal injury lawyer who will hold them accountable.
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.
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