Burlington Catastrophic Injury Lawyer

The survivors of motor vehicle accidents in Ontario who have sustained injuries as a result of their collisions should be entitled to no-fault accident benefits from their insurance provider. All basic auto insurance plans in the province are required to provide the mandatory minimum coverage amounts prescribed within the Ontario Statutory Accident Benefits Schedule (SABS).

No-fault accident benefits should be available to any party injured in a motor vehicle collision, even if their own mistakes behind the wheel were responsible for causing the accident to occur. The amount of benefits to which an injured party may be entitled is determined by the severity of the injuries they sustain in their accident.

When people sustain catastrophic impairments as a result of a motor vehicle collision, they often struggle under the burden of substantial financial losses. The individuals whose lives have been altered by severe, permanent injuries are entitled to higher amounts of accident benefits than those whose accident-related injuries are less severe.

The SABS requires all basic auto insurance plans in Ontario to include provisions for $1 million in combined medical, rehabilitation, and attendant care benefits for the rest of a catastrophically impaired accident survivor’s life. This amount is substantially higher than the $3,500 in medical and rehabilitation benefits for accident victims who sustained minor injuries, or the $65,000 in combined costs of medical, rehabilitation, and attendant care benefits for accident victims who sustained non-minor, non-catastrophic injuries.

In addition to determining the mandatory minimum amounts of coverage that must be included in all auto insurance policies provincewide, the SABS provides definitive eligibility criteria for higher amounts of accident benefits. According to the SABS, in order to meet the threshold of catastrophic impairment, a motor vehicle accident victim must have sustained one of the following permanent injuries as a result of their accident:

• 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 the 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 a mental or behavioural disorder

To apply for accident benefits commensurate with the severity of their injuries, a physician familiar with the catastrophically impaired claimant’s newly acquired medical condition must complete an OCF-19 form. This form should include pertinent information about the patient’s injuries and prognosis for the insurance provider to review and evaluate.

However, even though an applicant’s physician might agree that their injuries meet the threshold of catastrophic impairment, the insurance company reviewing the application may disagree. They may try suggesting that the injuries in question were related to a pre-existing condition and not the result of the claimant’s motor vehicle accident, or dispute the severity of the injuries sustained in order to provide the applicant with a lower settlement offer.

If your insurance provider denied your claim for accident benefits or offered you an unfairly low settlement amount despite your physician’s opinion that your injuries meet the threshold of catastrophic impairment, consider contacting us today. Our Burlington catastrophic injury lawyers may be able to represent your best interests and help you get the coverage you deserve.

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No one should have to take on a large insurance company on their own, especially not someone doing their best to readjust to regular life after sustaining a catastrophic impairment in a collision. To speak with our catastrophic injury lawyers serving Burlington today, call to receive a free initial consultation on your case.

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