Catastrophic Impairment in Ontario: Definition, Criteria, and Benefits

If you’ve been seriously hurt in a motor vehicle accident in Ontario, you may be eligible for a catastrophic impairment designation under the Statutory Accident Benefits Schedule (SABS). This designation is critical — it provides access to up to $1,000,000 in accident benefits, far more than non-catastrophic injuries.

But what exactly is catastrophic impairment, and how is it different from a catastrophic injury?

What Is Catastrophic Impairment?

A catastrophic impairment is a legal classification in Ontario that determines the highest level of accident benefits available after a car accident.

It goes beyond simply having a “serious injury.” To qualify, your condition must meet the strict criteria set out in the Statutory Accident Benefits Schedule, O. Reg. 34/10.

Catastrophic Impairment vs. Catastrophic Injury

• Catastrophic Injury → plain-language term for a severe injury (e.g., paralysis, brain injury, amputation).
• Catastrophic Impairment → the legal designation under SABS that gives access to enhanced benefits.

SABS Accident Benefit Levels

The type of injury determines how much coverage you can receive:

• Minor Injury Guideline (MIG): up to $3,500 for treatment
• Non-Catastrophic Injuries: up to $65,000 in benefits (over 5 years)
• Catastrophic Impairment: up to $1,000,000 in benefits (lifetime), plus access to housekeeping, caregiver, and attendant care supports

Catastrophic Impairment Criteria in Ontario

To be classified as catastrophically impaired, your injuries must fall into one of these categories:

1. Paraplegia or tetraplegia
2. Severe mobility impairment or limb amputation
3. Loss of vision in both eyes
4. Traumatic brain injury (adult or child-specific criteria)
5. 55% or more whole-person impairment (based on AMA Guides)
6. Marked or extreme mental/behavioural impairment that prevents useful functioning

Catastrophic Impairment Criteria 7 and 8

The SABS outlines eight possible criteria for catastrophic impairment. Two of the most debated are:

• Criterion 7: A physical impairment or combination of impairments resulting in 55% or more whole-person impairment.
• Criterion 8: A mental or behavioural disorder that causes Class 4 (marked) impairment in three or more functional areas or Class 5 (extreme) impairment in one area, preventing useful functioning.

SABS Catastrophic Impairment Benefits

If you qualify, you may access:

• Up to $1,000,000 in medical and rehabilitation benefits
• Attendant care funding
• Housekeeping and home maintenance benefits
• Caregiver benefits
• Lifetime coverage for many supports

This level of funding is designed to cover the extraordinary costs that catastrophic injuries create.

Applying for Catastrophic Impairment

The process typically involves:

1. Application (OCF-19 form): Completed by your treating physician or specialist.
2. Medical review: Insurers may require additional independent assessments.
3. Decision: The insurer must respond within 10 business days of receiving reports.
4. Appeal: If denied, you can challenge the decision at the Licence Appeal Tribunal (LAT)

Non-Catastrophic vs. Catastrophic: Why It Matters

Without catastrophic designation, you’re limited to $65,000 in coverage. With it, you gain 10x more benefits and crucial access to long-term care funding.

That’s why legal help is often necessary — insurers frequently dispute catastrophic applications, especially under criteria 7 and 8.

Key Takeaways

• Catastrophic impairment = Ontario’s legal definition for the most serious injuries.
• The designation provides access to up to $1,000,000 in SABS benefits.
• Criteria 7 and 8 deal with whole-person impairment (55%+) and serious mental/behavioural disorders.
• Applications are complex and often disputed, but appeals are possible.
• Legal guidance is essential to protect your rights.

Speak to a Catastrophic Impairment Lawyer in Ontario

If you’ve been seriously injured in an Ontario motor vehicle accident, don’t settle for less than you deserve. At Samfiru Tumarkin LLP, our lawyers have extensive experience handling catastrophic impairment claims, ensuring clients receive the maximum benefits under SABS.

📞 Contact us today for a free consultation and let us fight for the full support you need.