Navigating Catastrophic Injury Claims in Ontario: What You Need to Know

June 19, 2025, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Suffering a catastrophic injury—such as a brain injury, spinal cord damage, or multiple severe fractures—can change every aspect of your life. In Ontario, individuals who are catastrophically injured in motor vehicle accidents may be entitled to significantly higher benefits under the Statutory Accident Benefits Schedule (SABS).

However, the process of qualifying for catastrophic impairment status is complex and frequently contested by insurance providers. Here’s what you need to know if you or a loved one is navigating this difficult situation.

What Qualifies as a Catastrophic Injury?

Under Ontario law, catastrophic injuries are defined in precise medical terms. Some examples include:

• Paraplegia or quadriplegia
• Severe traumatic brain injury (TBI)
• Loss of vision in both eyes
• Amputation or severe impairment of limbs
• Marked or extreme mental or behavioural impairment
• A combination of impairments resulting in 55% or more whole person impairment

This designation is crucial because it dramatically increases access to medical, rehabilitation, and attendant care benefits—up to $1 million or more.

The Assessment Process

To be deemed “catastrophically impaired,” a medical evaluation must be conducted according to strict criteria. This may involve a team of specialists including neurologists, psychologists, orthopaedic surgeons, and occupational therapists.

Insurance companies may require Independent Medical Examinations (IMEs), and it’s not unusual for them to dispute or delay a catastrophic injury designation.

At Deutschmann de Koning Personal Injury Law, we work closely with highly qualified medical experts to ensure that your condition is accurately assessed and documented.

Why the Designation Matters

Without a catastrophic designation, your accident benefits may be capped at:

• $65,000 for medical and rehabilitation expenses (non-catastrophic)
• $3,500 if your injuries are deemed minor

For someone with a life-altering injury, these limits can be exhausted quickly. The catastrophic designation opens access to much more comprehensive care and support, which may include:

• Long-term home modifications
• Attendant care services
• Mobility aids and equipment
• Ongoing psychological therapy
• Vocational retraining (if possible)

Legal Support Is Essential

Navigating the catastrophic injury claim process can be overwhelming, especially when you are focused on recovery. Insurers are often reluctant to grant catastrophic status without legal pressure and strong supporting documentation.

Our legal team at Deutschmann de Koning:

• Coordinates timely and thorough medical assessments
• Challenges unfair denials and delays by insurers
• Advocates for full compensation and benefit entitlement
• Supports families through every stage of the claim

We understand the profound impact a catastrophic injury has on both the injured person and their loved ones. Our goal is to relieve the legal and financial burdens so you can focus on healing and rebuilding your life.

Your Road to Recovery Starts Here

If you or someone you care about has suffered a serious injury in Ontario, you don’t have to go through it alone. Let the experienced team at Deutschmann de Koning Personal Injury Law help secure the benefits and compensation you need to move forward.

Contact us today for a free, no-obligation consultation.

About Deutschmann de Koning Law

Deutschmann de Koning Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann and Nick de Koning focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.ddinjurylaw.com or call us at 1-519-742-7774.