What is a Catastrophic Injury?

A catastrophic injury is a severe, life-changing injury that has a profound impact on one’s ability to return to their pre-accident lifestyle. These injuries have major financial ramifications as they typically prevent an individual from returning to work and result in costly medical and rehabilitation expenses.

In personal injury cases that do not arise from a car accident, the term ‘catastrophic injury’ may simply describe the severity of your injuries. In this sense, the word catastrophic is merely an adjective describing your injury.

However, in car accident cases leading to a claim for accident benefits, the term catastrophic impairment is specifically defined by the Statutory Accident Benefits Schedule. If your injury meets this definition, then your medical, attendant care, and rehabilitation limits will increase to $1,000,000 or more if you purchased optional benefits.

If you have sustained serious injuries, it is imperative to retain a knowledgeable personal injury lawyer to fully investigate your injuries and pursue all avenues of compensation. In the context of a car accident claim, this may also include applying for a determination of catastrophic impairment whether you are at fault for the accident or not. Call Hillier & Hillier at 905-453-8636 for a FREE CONSULTATION or click here to submit an online request for a FREE CONSULTATION.

What is a Catastrophic Impairment in Ontario?

Section 3.1 of the Statutory Accident Benefits Schedule (“SABS”)  provides eight definitions of a catastrophic impairment as follows:

1. Paraplegia or tetraplegia that meets additional medical criteria such as limited motor or sensory functioning.

2. Severe impairment of mobility or use of an arm, or an amputation including certain leg amputations (shin or higher), an amputation of an arm or other impairment causing total and permanent loss of use of an arm, or a severe and permanent impairment to both legs.

3. Loss of vision in both eyes that meets the visual acuity or field-of-vision requirements prescribed by the SABS.

4. For injured individuals aged 18 or older, a traumatic brain injury involving specific findings on diagnostic imaging coupled with a level of neurological impairment as prescribed by the SABS.

5. For injured individuals under the age of 18, a traumatic brain injury for which the individual is accepted to a public hospital with positive findings on certain diagnostic imaging as prescribed by the SABS, or the child is accepted to a prescribed neurological rehabilitation program on an in-patient basis, or the child meets a certain level of disability as further prescribed by the SABS.

6. A physical impairment or combination of physical impairments resulting in a 55% or more physical impairment of the whole person.

7. A mental or behavioural impairment, excluding traumatic brain injury, that when combined with a physical impairment in paragraph 6 results in a 55% or more impairment of the whole person.

8. An impairment that results in a class 4 (marked impairment) in three or more areas of function that precludes useful functioning or a class 5 (extreme impairment).

You may only apply for a determination of catastrophic impairment under paragraphs 6-8 after a prescribed amount of time has passed, which is often six months or two years depending on the circumstances.

Finally, the claimant’s impairment must be caused by the accident. Although this may appear straightforward, causation can become a significant issue where an injured person had pre-existing medical conditions or sustained unrelated injuries after the accident.

It is also important to note that you may only access accident benefits if you sustained your injuries in a car accident. Otherwise, you cannot access these benefits.

Why Does a Catastrophic Designation Matter?

A catastrophic designation is important because it will enable you to access $1,000,000 in limits for medical, rehabilitation, and attendant care over your lifetime, as opposed to limits of $65,000 for non-catastrophic injuries for a period of five years, or limits of $3,500 for minor injuries for five years following the accident.

This means that the insurance company will pay you up to $1,000,000 for reasonable and necessary expenses for treatment required throughout your life. If you obtained optional benefits, these limits may increase up to $3,000,000.

There is an additional nuance with the attendant care benefit. If you sustained a non-catastrophic impairment, you may receive up to $3,000 per month in the five years following the accident. If you sustained a catastrophic impairment, you may receive up to $6,000 per month in attendant care over your lifetime or until your limits for medical, rehabilitation, and attendant care are exhausted. If a family member provides you with attendant care, and it is not their ordinary occupation to provide such care, they may be compensated for their income loss for taking time off work up to $6,000 per month.

The designation is also important because it may unlock other benefits depending on when you renewed your insurance policy and whether you purchased optional benefits.

If your current auto policy was renewed prior to July 1, 2026, then a catastrophic designation will unlock the following benefits:

• Housekeeping benefits up to $100 per week so long as you suffer a substantial inability to perform your housekeeping and home maintenance chores that you normally did before the accident.

• Caregiver benefits of $250 per week so long as you are substantially unable to engage in your pre-accident caregiving activities. Note that if you care for multiple individuals at the time of an accident, you will receive an additional $50 per week for each additional person in need of care. You may continue to receive this benefit after the two-year anniversary of the accident so long as you are suffering a complete inability to carry on a normal life. Finally, you cannot receive the caregiver benefit if you have elected to receive an income replacement benefit or non-earner benefit.

By contrast, if you sustained a non-catastrophic injury, you may only receive the above housekeeping and caregiver benefits if you purchased these as optional non-catastrophic benefits.

If your current insurance policy was renewed or entered into after July 1, 2026, then a catastrophic designation will still increase your limits for medical, rehabilitation, and attendant care expenses to $1,000,000, or more if you purchased optional benefits.

However, regardless of whether you sustained a catastrophic injury, you may no longer be entitled to caregiver, housekeeping, non-earner, or income replacement benefits unless these benefits are included as optional coverage under your policy. Typically, your insurance policy will renew after July 1, 2026, with these benefits in place, and you will pay additional premiums for these benefits.

This also applies if you sustained a non-catastrophic injury or minor injuries, in which case you will only be entitled to limits of $65,000 or $3,500 for medical, rehabilitation, and attendant care expenses for five years, unless you purchased additional optional benefits.

Finally, regardless of when you renewed your auto policy, a designation of catastrophic impairment will also unlock funding for case management services, which are not available for non-catastrophic injuries. Case managers are invaluable and help plan your treatment regimen and refer you to different treatment providers.

If you sustained a catastrophic impairment, you will be entitled to the above benefits whether you were at fault for the accident or not.

For more information on accident benefit claims, click here. For further information on how changes to the law, effective July 1, 2026, may impact your ability to access certain benefits, click here.

What If My Insurance Company Does Not Agree that I Sustained a Catastrophic Injury?

If your insurance company refused to designate your injuries as catastrophic, then, if appropriate, an application to dispute the insurer’s refusal must be filed with the Licence Appeal Tribunal, otherwise known as a LAT application.

This application may ultimately lead to a hearing before an adjudicator where you and the experts retained in support of your claim for catastrophic impairment will provide evidence. The insurance company will likewise produce their own experts who will provide evidence at the hearing.

After all relevant evidence is heard, the adjudicator will then decide whether you sustained a catastrophic injury.

If the adjudicator agrees with the insurance company, then you may launch a formal request for the adjudicator to reconsider their decision, and if that fails, you may apply to the Divisional Court for a review of the adjudicator’s decision.

You have two years from the date of the insurer’s refusal to recognize your injuries as catastrophic to commence an application to dispute this insurer’s denial.

Can I Settle My Accident Benefits Claim If I Sustained a Catastrophic Injury?

Yes, and this is also why a catastrophic designation is important. You may receive a portion of your remaining limits as a lump sum. Individuals who sustained catastrophic impairments will typically receive much larger settlements than those who do not.

However, to pursue settlement, medical and accounting evidence is often required to determine your future treatment needs and the present value cost of these. The benefit of a settlement is that you do not require approval from the insurance company before spending money on treatments or other expenses. By contrast, if you keep your claim open, you generally require approval from your insurance company who will fund your treatments.

Catastrophic Injuries Beyond the Accident Benefits Context

Individuals who sustain catastrophic injuries may also pursue a lawsuit, known as a tort claim, against the at-fault defendant. Such injuries can arise from medical malpractice, car accidents, trip and fall or slip and fall claims, or product liability.

Unlike accident benefits, which you can claim whether you were at fault for the accident or not, to be successful in a lawsuit you must establish that the defendant was negligent and thereby caused your damages.

You may be entitled to the following forms of compensation (“heads of damages”) in a lawsuit:

• General damages for pain and suffering: this is meant to compensate you for the impact of your injuries on your life. Unlike the United States, there is a limit on the amount that can be awarded for general damages, which is approximately $461,748.63 as of 2026. This figure increases each year for inflation. Individuals who sustain catastrophic injuries tend to receive larger awards for pain and suffering than those who do not. However, the value of your claim for general damages depends on the facts of your case and the overall impact of your catastrophic injuries on your life. For more information on awards for general damages for pain and suffering, click here. 

• Income loss or loss of competitive advantage: this head of damage is intended to compensate you for any income you have lost and may lose in the future as a result of your catastrophic injury. Individuals who were employed at the time of an accident and are unable to return to work because of catastrophic injuries may experience a significant loss of income. Even if you were not employed, but perhaps in an educational program, you may still have a loss of income if you cannot pursue a certain career path. As well, individuals who return to work after a catastrophic injury may experience a loss of competitive advantage in that they are unable to pursue promotions or may in the future experience diminished earnings due to their injuries. This head of damage is intended to compensate you for any economic loss you may experience due to your injuries. Again, the value of a claim for loss of income or competitive advantage is dependent on the facts of your case. For more information on loss of income and competitive advantage, click here.

• Cost of care: this head of damage is meant to compensate you for the cost of medical, rehabilitation, and attendant care that you may require because of your injuries and that is not covered by OHIP. Individuals who sustain catastrophic injuries often require extensive and costly care including but not limited to physiotherapy, psychotherapy, attendant care, occupational therapy, non-OHIP covered medications, and speech-language pathology. To advance a claim for the cost of care, it is necessary to retain medical experts to recommend the types of care required and a certified life care planner to estimate the costs of their recommendations.

• Housekeeping and Home Maintenance: this head of damage is intended to compensate you for the cost of assistance you require to complete your pre-accident housekeeping and home maintenance tasks. Again, it is imperative to retain medical experts to opine on whether you require such assistance because of your injuries.

The Interaction of Accident Benefits and Tort Lawsuits in Car Accident Cases

A catastrophically injured car-accident plaintiff may have both an AB claim and a tort lawsuit against the at-fault driver, but benefits are generally accounted for to prevent double recovery.

The Role of Medical Experts and Other Experts in Catastrophic Injury Claims

Medical experts are essential to successfully claiming damages in a personal injury lawsuit and determining whether you meet the definition of catastrophic impairment in an accident benefits claim.

Medical experts may also be required to comment on whether you can return to work due to your injuries and whether you require care and assistance with your housekeeping and home maintenance tasks.

You may also need to retain a certified life care planner who can estimate the cost of future care and housekeeping and home maintenance assistance.

Evidence from an accountant may be required to calculate your income loss and the cost of medical care and housekeeping and home maintenance assistance required over your lifetime.

Finally, you may also need additional experts, such as an engineer, to address issues of liability and fault.

How Hillier & Hillier Builds a Catastrophic Injury Case

Personal injury lawsuits, particularly those involving catastrophic injury claims, are expert-intensive and the cost of retaining these experts is significant. Experts are also required to pursue a claim for accident benefits and achieve a designation of catastrophic impairment.

At Hillier & Hillier, we build catastrophic injury cases by gathering all relevant records and retaining renowned and credible experts to comment on the heads of damages. We frequently consult with our network of medical experts to obtain evidence in support of our clients’ tort lawsuit or claim for accident benefits.

Further, we absorb the up-front costs of retaining these experts, and seek to recover these costs from the defendant in a lawsuit or from the proceeds of an accident benefits settlement. This way, you do not need to incur significant up-front costs to build your case.

Choosing the correct expert, and ensuring they have all relevant information, is an extremely important task that must be done properly to maximize the chance of a positive outcome in your case.

Your case must be fully investigated whether your injuries are catastrophic or not. This may require consulting not only with medical experts, but also with engineers, accountants, life care planners, and vocational experts to ensure that there is sufficient evidence supporting your claim.

The lawyers at Hillier & Hillier have represented thousands of injured individuals and have extensive experience working with experts to build and support their cases.

Frequently Asked Questions

Q. How is catastrophic impairment determined?

A. You will undergo assessments with medical specialists to determine if your injuries meet the definition of catastrophic impairment in section 3.1 of the Statutory Accident Benefits Schedule. Your insurance company may require you to also undergo similar assessments with their own medical experts.

After these assessments, your insurance company may determine that your injuries meet the definition of catastrophic impairment. If your insurance company denies that you sustained a catastrophic impairment, then you must commence an application with the Licence Appeal Tribunal to overturn the insurer’s denial.

This application may lead to a hearing where you and all relevant witnesses and medical experts will give evidence. The adjudicator will then provide a decision as to whether or not you sustained a catastrophic impairment.

If the adjudicator agrees with the insurer, you may ask for a formal reconsideration of the decision, failing which you may apply to the Divisional Court for a review of the adjudicator’s decision.

Q. How long does a CAT determination take?

A. It depends on the circumstances. For some types of injury, you may not be able to undergo assessments to determine if you meet the definition of catastrophic impairment until 6 months or even 2 years after the accident.

For other types of injury, it may take several months or up to a year following an accident to refer you to relevant assessors, undergo further assessments with the insurance company’s assessors, and then for an insurer to reach a determination.

If you must commence an application to the Licence Appeal Tribunal, it could take several years following an accident for this determination to be made.

Q. Can I receive accident benefits and sue?

A. Yes, and if you pursue a lawsuit arising from a car accident then you will also need to commence a claim for accident benefits. As mentioned above, the defendant will receive a credit for any accident benefits received from a corresponding award for damages.

Q. How much is a catastrophic injury case worth?

A. It depends on the facts of each case. Cases involving individuals who are unable to return to work and require significant amounts of care and housekeeping assistance will be worth much more than cases involving individuals with similar injuries who are able to return to work and do not require much care or assistance. For more information on how the value of a personal injury case is assessed, click here.

Q. How long do I have to sue?

A. You have two years from the date you discovered your claim to commence a lawsuit. The date you discovered your claim is when a reasonable person with your abilities first ought to have known when the injury, loss or damage had occurred. Typically, in car accident cases, this is two years from the date of the accident.

Q. How much does a catastrophic injury lawyer cost?

A. We collect our legal fees on a contingency basis. That is, you do not pay for our legal services unless you successfully recover damages from the at-fault defendant or obtain compensation by settling your accident benefits claim. We charge up to a maximum of 30% of the amount recovered for tort claims (lawsuit) and up to a maximum of 20% of settlements obtained in an accident benefits claim.

The lawyers at Hillier & Hillier have extensive experience representing individuals with catastrophic injuries in tort lawsuits as well as accident benefit claims. We have a large network of medical, accounting, and life care experts with whom we consult to build our clients’ cases and obtain meaningful compensation. Contact Hillier & Hillier at 905-453-8636 to schedule a FREE CONSULTATION or click here to submit an online request for a FREE CONSULTATION.