Lawyers must go extra step to meet special needs of the ‘catastrophically’ injured

Author: Rohan Haté Professional Corporation |

Lawyers must go extra step

The life-changing nature of a catastrophic injury demands an extra level of commitment from your law firm, says Toronto insurance lawyer Rohan Haté.

The relatively rare “catastrophic impairment” designation is a technical term used to describe the most seriously injured accident victims in Ontario’s Statutory Accident Benefits Schedule (SABS), and Haté, a lawyer with Rohan Haté Professional Corporation, says advocacy skills are not enough on their own to properly support those unfortunate enough to meet the definition.

“You need a system set up to get clients the assessments they need, not only to have their injuries designated as catastrophic, but also to make sure they are going to be able to get the care they need on a very long-term basis,” he says. “We deal with catastrophically impaired cases all the time, so we are well set up to get clients the support they need.”

Limited resources under SABS

Getting a catastrophic designation can make a huge difference to the level of funding insurers will provide for an accident victim’s care, since the limit without one for combined attendant care and medical and rehabilitation services stands at just $65,000.

For catastrophically injured people, the cap rises to $1 million, although that is still way down on the $2-million limit in place before reforms that took place under the previous provincial government in 2016. Even with the lower cap, Haté says insurers frequently deny claims, and some severely injured people will have more trouble than others establishing that their impairments are serious enough to meet the “catastrophic” threshold.

“There are various different ways your injuries can be determined as catastrophic and it’s important to have a lawyer who understands each of those pathways,” he adds.

For example, claimants who can show that they have suffered paralysis, amputation, complete loss of vision in both eyes, or those who have a low enough score on the Glasgow Coma Scale in the months after their accident, are unlikely to meet much resistance from their insurance company, since all of these impairments are considered catastrophic under the SABS definition.

Assessing short-term and longer-term needs

Haté says insurers are more likely to mount an aggressive defence in cases relying on the SABS’ “whole person” impairment provisions, where combinations of less straightforward mental or physical diagnoses are required to meet the definition of catastrophic.

In the weeks and months after an accident, catastrophically impaired accident victims and their family members begin looking beyond the immediate recovery and coming to terms with the lifelong impact of their injuries, and Haté says they often need help from a wide variety of medical professionals. His firm assists them in connecting with cognitive therapists, physical therapists, occupational therapists, personal support workers, psychologists and others, depending on their individual needs.

Looking to the longer term, the firm also helps clients find experts to forecast the required cost of their medical and rehabilitation care well into the future, as well as any modifications that may be needed to adapt their homes to accommodate their diminished physical abilities.

Arranging structured settlements

Once a final agreement has been reached with the insurance company, Haté often liaises with structured settlement companies to arrange for its payment over the long period the cash will be needed. Because of the large size of awards often made to catastrophically injured accident victims, he says it usually makes sense to take advantage of these financial products, which divide court-ordered payouts into regular tax-free installments as an alternative to a lump sum payment.

“We work with these companies to structure regular payments on a monthly or annual basis, depending on the needs of the client,” Haté says.

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