McLeish Orlando's Catastrophic Injury Lawyers

Catastrophic injuries can be caused by a variety of factors. Some of the most common causes of catastrophic injuries are:

  • Car accidents
  • Motorcycle accidents
  • Pedestrian-motorist collisions
  • Cycling-motorist collisions

Lawyers at McLeish Orlando have extensive experience in dealing with such cases.

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In addition to receiving benefits from your own insurer, an individual who has been seriously injured as a result of a motor vehicle incident is entitled to sue the negligent party for damages. The tort system (lawsuit) s designed to put the innocent injured party in the financial position that he or she would have been if the injury had not occurred. Some of the heads of damages in a tort action include:

  • Loss of past income
  • Loss of future income
  • Cost of attendant care and future care
  • Housekeeping and home maintenance
  • Special damages
  • General damages for pain and suffering and loss of enjoyment of life

 

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If You Or Your Loved One Have Suffered From A Catastrophic Injury, Our Lawyers Can Help!

Call us 24/7 at 1-866-685-3311 or… Talk to a lawyer

Catastrophic injuries are the most serious forms of personal injuries. These include spinal cord injuries, traumatic brain injuries, amputation, loss of vision, severe orthopaedic injuries, and more. Those who have suffered catastrophic injuries have access to additional benefits, called “Statutory Accident Benefits” (SABS), when their injuries arise out of the use or operation of an automobile.

If injured in an accident that involves an automobile, it is critical to know your rights and understand what benefits you have access to. The personal injury lawyers of McLeish Orlando are experienced in holding insurance companies accountable and ensuring that catastrophically injured people receive the benefits that they are entitled to.

What is a Catastrophic Impairment?

What constitutes a catastrophic impairment, or catastrophic injury, is governed by legislation called the Statutory Accident Benefits Schedule (SABS). There are many different ways for an injured individual to be deemed catastrophically impaired. Knowing which is applicable in each case is critical to ensuring maximum benefits are available.

Below are the 8 separate criteria for catastrophic impairment as outlined in the SABS:

  1. Paraplegia or tetraplegia
  2. Severe impairment of ambulatory mobility or use of an arm or leg, or amputation of an arm or leg
  3. Loss of vision of both eyes
  4. If the person is over 18: traumatic brain injury, provided that the brain injury is confirmed by medical imaging and a Glasgow Outcome Scale assessment determines that the injury results in one of the following ratings:
    A. Vegetative State, one month or more after the accident,
    B. Upper Severe Disability or Lower Severe Disability, six months or more after the accident, or
    C. Lower Moderate Disability, one year or more after the accident.
  5. If the person is under 18 years of age: a traumatic brain injury, confirmed by medical imaging, and the person has been admitted into hospital, or, the person has severely impaired neurological functioning
  6. A physical impairment or combination of physical impairments that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in 55 percent or more physical impairment of the whole person.
  7. A mental or behavioural impairment, excluding traumatic brain injury, determined in accordance with the rating methodology in the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 6th edition, 2008, that, when the impairment score is combined with a physical impairment described above results in 55 percent or more impairment of the whole person.
  8. An impairment that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in a class 4 impairment (marked impairment) in three or more areas of function that precludes useful functioning or a class 5 impairment (extreme impairment) in one or more areas of function that precludes useful functioning, due to mental or behavioural disorder.

Understanding catastrophic impairment is a highly technical analysis. Each case is different. It is important to have an experienced personal injury lawyer who understands the different criteria and has experience working with catastrophically injured individuals.

Catastrophic Injury and Compensation

While being a descriptor for the most serious injuries, the term “Catastrophic” is also a legal definition with important repercussions for your case. If an injury is caused by the use or operation of an automobile, then the injured person is entitled to no-fault accident benefits. Examples include: car accidents, motorcycle accidents, cyclists struck by an automobile, and pedestrians struck by an automobile.

There are three different levels of severity for accident benefits, with each level giving access to more benefits. The three levels, from least to most serious are:

  1. The Minor Injury Guideline (MIG): individuals who fall under the MIG are only entitled to up to $3,500 for their medical-rehabilitation needs.
  2. Non-Catastrophic Impairment (non-CAT): an individual who does not fall into the MIG and who does not qualify for a catastrophic impairment will be deemed to be non-catastrophic. They will have up to $65,000 for their medical-rehabilitation needs and attendant care funding.
  3. Catastrophic Impairment (CAT): an individual who is deemed catastrophically injured is entitled to up to $1,000,000 for their medical-rehabilitation needs and attendant care funding.

How We Can Help?

With so much at stake, it is crucial that you hire a personal injury lawyer that has experience with handling cases involving catastrophic injuries.

The personal injury lawyers of McLeish Orlando have extensive experience handling claims involving catastrophic injuries. In order to obtain maximum benefits, it is necessary to hold insurance companies accountable for their obligations to injured individuals. To do this, it is often necessary to proceed to a hearing for a catastrophic determination from an adjudicator. It is important that your personal injury lawyer has a reputation in the insurance industry of being prepared to effectively advocate at a hearing should it be necessary. The lawyers of McLeish Orlando have extensive experience appearing at arbitrations and are recognized as leaders in the industry when it comes to advocating on behalf of our clients.

Criteria for Accessing Accident Benefits

One aspect of accessing accident benefits that makes the process so complicated is that different criteria apply depending on what specific accident benefit is being applied for. For example, one set of criteria applies for accessing medical-rehabilitation benefits, while a different set of criteria applies for accessing income replacement benefits.

Significance of Catastrophic Impairment Designation

Impact Regarding Accident Benefits

Individuals that are deemed catastrophically impaired are entitled to the maximum amount of benefits under the SABS. A catastrophically impaired individual is entitled to up to $1,000,000 in accident benefits, which is a substantial increase from the non-catastrophic maximum of $65,000.

Impact in a Negligence Claim for Damages

An important consequence of an individual being deemed catastrophically impaired is that in a negligence lawsuit for damages, a catastrophically impaired individual is entitled to make a claim against the negligent driver and owner of the vehicle for future cost of care. Receiving future cost of care damages ensures that an injured individual is adequately compensated so that they are able to access the care they require for the rest of their life.

Individuals who are not deemed catastrophically impaired can only claim for loss of household and handyman capacity. This results in reduced compensation for the injured individual.

Practical Difficulties in Catastrophic Impairment Cases

 The Amount at Stake:

A catastrophically impaired individual is entitled to up to $1,000,000 in accident benefits (health/rehab and attendant care), versus only $65,000 if they are deemed non-catastrophic.

This means that there is a lot of money at stake for insurance companies. The amount an insurance company will have to pay increases substantially.

Because there is so much at stake for an insurance company, they will try their hardest to ensure a catastrophic impairment designation is not reached. They may be tempted to choose doctors to conduct insurer medical examinations that they feel will promote their position. They will not let such a designation come by easily.

One way for an injured person to contend with such an approach by an insurance company is to have the right people on your side.  This means lawyers who are able to retain and  fund the leading specialists, physicians, neuropsychologists and other health professionals to conduct comprehensive assessments on the catastrophic impairment issue.   Our personal injury lawyers have years of experience dealing with these issues and have developed strong relationships with leading medical professionals in the industry.

 Insurer Examinations

Insurance companies that are obligated to pay accident benefits have a right to insurance examinations pursuant to section 44 of the SABS. Section 44 of the SABS states:

44.(1) For the purposes of assisting an insurer to determine if an insured person is or continues to be entitled to a benefit under this Regulation for which an application is made, but not more often than is reasonably necessary, an insurer may require an insured person to be examined under this section by one or more persons chosen by the insurer who are regulated health professionals or who have expertise in vocational rehabilitation.

Importantly, section 44 does not give an insurance company full discretion to have an injured person examined by whomever the insurance chooses and whenever the insurance chooses. Sometimes an insurance company will try to have an insurer examination conducted by a kinesiologist or by a social worker. These individuals are not members of a health profession and generally speaking are not people with expertise in vocational rehabilitation. Accordingly, they should not be conducting insurer examinations. Additionally, insurance companies have an obligation to make reasonable efforts to schedule the examination for a day, time, and location that is convenient to the person being examined. The SABS provides additional conditions, restrictions, and limits on what an insurer can and cannot do in respect to insurer examinations. Our knowledgeable team of personal injury lawyers will ensure that your insurer plays by the rules and does not prejudice your case.

Choosing the Right Case Manager

Case managers have an important role in your recovery. Case managers coordinate with you, your lawyers, the insurance company, and treatment professionals, to determine your recovery needs. The case manager then works with you and the rest of your team to develop an effective treatment plan.

It is an important right of an injured person to choose their own case manager. However, sometimes insurance companies appoint a case manager to an injured person’s file before that person has a chance to speak to a personal injury lawyer. When that happens, we almost always replace that case manager with one that can be trusted to not be influenced by the interests of the insurance company. We want a case manager on your case whose sole and exclusive goal is to assist you as much as possible with your rehabilitation and recovery.

At McLeish Orlando, depending on the nature of your injury, where you live, and a number of other factors, we will provide you with a list of highly skilled and knowledgeable case managers, with strong people skills, who can deal with an oftentimes confrontational insurance adjuster, and let you choose the case manager that you think is best suited for your needs.

This ensures that you are having your individual needs addressed and that your accident benefits are being used in the most efficient way possible to maximize your recovery.

Going Beyond the Law to Help Our Clients

Suffering a personal injury such as a spinal cord injury, brain injury, or orthopaedic injury is an extremely traumatic experience that can significantly impact your life as well as your family’s.

The stress involved in being in an adversarial position with an insurance company can easily make this situation overwhelming. We understand this and we will do our best to not only address your legal issues, but to shield you and your family members from the worry of litigation. At McLeish Orlando, we do this in several ways:

  1. Assign a specially trained accident benefits coordinator to your team to deal with all your accident benefit issues, including providing immediate help when an insurance company fails to do something it should be doing
  2. Copy you on all correspondence delivered and received so that you know exactly what is going on in your case at all times
  3. Make sure that only highly trained and skilled health professionals are retained to assist you with your rehabilitation
  4. Aim to conclude all aspects of the litigation process in a manner where you receive as fair a settlement as possible, as quickly as possible

At McLeish Orlando, our catastrophic injury lawyers have years of experience navigating this area of injury law.  We ensure that you receive the treatment and care you need and deserve. If you or a loved one have suffered a serious personal injury, contact our office at our toll-free number for a free consultation with one of the catastrophic injury lawyers.

 

 

Catastrophic Injury FAQs

What qualifies catastrophic injury?

A catastrophic injury is specifically defined under the  Statutory Accident Benefits Schedule, which sets out the benefits available to those persons who are injured directly or indirectly by the use or operation of a motor vehicle.  In Ontario, there is a higher level of statutory accident benefits available to an injured person when the injury or injuries they have sustained meet the definition of catastrophic impairment. If you suffer an injury in a motor vehicle accident, you can apply and be assessed for a determination of whether your injury qualifies as “catastrophic”.

What are common types of catastrophic Injuries?

The Statutory Accident Benefit Schedule defines catastrophic impairment as any one of the following:

  • Paraplegia or tetraplegia
  • Traumatic brain injury
  • Blindness or a loss of vision of both eyes
  • Amputation or severe impairment of the ability to move or use one arm or to walk independently
  • Physical impairment or a combination of physical impairment that results in 55 percent whole person impairment
  • Marked mental/behavioral disorder in three or more areas of function

It is important to note that the designation of a catastrophic injury is different for children than for adults with regard to brain injuries. This is because a brain injury in children may not be immediately apparent. For other injuries, including spinal injuries, blindness, loss of limbs, etc., children are evaluated for a catastrophic injury in the same way as adults. For more information about catastrophic impairment please click the following link: https://www.mcleishorlando.com/blog/what-is-catastrophic-impairment/

What medical treatments are there for catastrophic Injuries?

When classified as having sustained a catastrophic impairment by your automobile insurer, an injured person has access to one million dollars over their lifetime for medical benefits, rehabilitation benefits, and attendant care benefits.

Can I sue for a Catastrophic Injury?

In addition to receiving benefits from your own insurer, an individual who has been seriously injured as a result of a motor vehicle incident may be entitled to sue the other involved party for damages. The tort system is designed to put the innocent injured party in the financial position that he or she would have been if not injured through a third party’s negligent act.  Some of the heads of damages in a tort action include:

  • Loss of past income
  • Loss of future income
  • Cost of attendant care and future care
  • Housekeeping and home maintenance
  • Special damages
  • General damages for pain and suffering and loss of enjoyment of life

Why hire a catastrophic injury lawyer?

A person who receives a catastrophic designation from their insurer is entitled to claim up to a maximum of $1,000,000 over their lifetime for medical and rehabilitation benefits.  Conversely, a person with a non-catastrophic designation is only entitled to claim $65,000 in medical and rehabilitation benefits over the 5 years following the accident.  Hiring an experienced personal injury lawyer is essential in obtaining a catastrophic designation from your insurer.  OHIP-funded health care for individuals who have been seriously injured in a car accident can be inadequate. OHIP does not cover treatment by physiotherapists, massage therapists, speech-language pathologists, occupational therapists or psychologists, nor does OHIP fund medication, assistive devices, or home modifications. In addition, the consequences of a serious injury can be life-long and have significant financial and emotional consequences.  These needs and challenges will need to be addressed with the help of your lawyer.

Does your firm handle catastrophic injury cases?

Yes, our firm has a proven track record of helping injured victims who have sustained catastrophic injuries.  For example, some of our successes representing seriously injured individuals, please see the attached link: https://www.mcleishorlando.com/results-matter/

Can your firm provide me with the right access to the medical and rehabilitation benefits?

We take great pride in knowing that in addition to making sure our clients receive the best legal services in their lawsuits, our firm makes a commitment to every client to ensure that their medical and rehabilitation needs are also being cared for. McLeish Orlando Lawyers LLP has a network of medical and rehabilitation providers throughout the province that are very highly regarded and who are able to assist clients all over Ontario.

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