Does my injury affect which types of Accident Benefits are available to me?

Injuries are classified under three types for the purposes of accident benefits. The classification of your injuries will determine the benefits that are available to you.

Minor injuries

The SABS defines a minor injury as a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae. If you have suffered an injury that corresponds with the designation of a minor injury, you will only qualify for the benefits found in the Minor Injury Guidelines. You are entitled to the general benefits, as well as:

• Medical and rehabilitation benefits to a maximum of $3,500 over a period of 5 years (The $3,500 maximum can be increased to $65,000 if there is compelling evidence that a pre-existing medical condition will prevent you from achieving maximal recovery if you are subject to the $3,500 cap).

You are not entitled to:

• Attendant care benefits
• Housekeeping benefits
• Caregiver benefits

Non-catastrophic injuries

If you have suffered injuries that are not deemed to be minor, but are not catastrophic, you are considered to be suffering from non-catastrophic injuries. You will receive more benefits than those suffering from injuries deemed to be minor, but less than those suffering from catastrophic impairments.

You are entitled to the general benefits, as well as:

• Medical and rehabilitation benefits (including attendant care benefits) to a maximum of $65,000 over a period of 5 years.

You are not entitled to:

• Housekeeping benefits
• Caregiver benefits

Catastrophic injuries

There are specific benefits reserved to those suffering from catastrophic injuries. The SABS defines a catastrophic impairment injury (“CAT”) as an injury that causes paraplegia, tetraplegia, severe impairment of ambulatory mobility or use of an arm, or amputation of an arm or leg, the total loss of vision in both eyes, a traumatic brain injury, injuries that result in 55% or more of the whole person being incapacitated or an injury causing a class 4 or 5 impairment in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment.

In order to be considered to be suffering from a catastrophic impairment, you must make an application under the SABS. Your CAT designation application must be signed by a physician or a neuropsychologist. Within 10 days of your application, the insurer must respond as to whether they approve the designation or not. Once approved, an insurer cannot unilaterally reverse its determination that you suffered a catastrophic impairment without utilizing the dispute resolution process set out in the Insurance Act.

If you have been successful in obtaining a CAT designation, you are entitled to:

• Medical and rehabilitation benefits (including attendant care and case manager services benefits) to a maximum of $1,000,000;
• Housekeeping benefits in the amount of $100 per week;
• Caregiver benefits to a maximum of $250 per week for the first person in need of care plus $50 per week for dependents in need of care if you are substantially unable to engage in caregiving activities in which you were involved in at the time of the accident.