People injured by a motor vehicle insured in Ontario have access to tiered accident benefits, called Statutory Accident Benefits (“SAB’s”). The available benefits are tiered because they starting at a base level and can be increased and/or broadened for an additional premium when the insurance coverage is purchased, and additionally, the limits can also vary depending on the degree of impairment sustained. To trigger the maximum limits available, a claimant must demonstrate that they have sustained “catastrophic” impairments: there is a complex maze of requirements and tests to satisfy before someone will be considered to have sustained catastrophic impairment from the consequences of a motor vehicle accident.
But what about family members who are not directly injured in a motor vehicle accident, but otherwise still suffer from psychological or mental disability when their loved ones are hurt in a motor vehicle accident: are they allowed to claim accident benefits, and are they able to apply to have their impairments declared “catastrophic” to gain access to the enhanced limits. The answer to the first question is “yes:” accident benefits are available to them if they qualify.
This recent case helps answer the second question in the affirmative. In this case, a parent allegedly suffered from profound psychological impairment when their child was injured in bicycle accident with a motor vehicle. The parent asked for their impairments to be classified as “catastrophic.”
The tribunal initially deciding this case ruled against the parent. Although capable of receiving accident benefits, the Tribunal concluded that the parent was not eligible to apply to have their impairments classified as “catastrophic” so as to be entitled to receive the enhanced coverage. Indeed, the Tribunal was asked to reconsider their decision, and following a review, the Tribunal maintained that their decision was correct.
The denial was appealed, and the Divisional Court reversed the Tribunal’s ruling, and granted the parent the right to request that their psychological injury warranted a catastrophic impairment designation. The matter was returned to the Tribunal to undertake the task of determining whether the parent’s impairments satisfied the test for catastrophic impairment.
Kellerman-Bernard v. Unica Insurance Company, 2023 ONSC 4423 (Div. Ct.)
https://www.canlii.org/en/on/onscdc/doc/2023/2023onsc4423/2023onsc4423.html