How Do I Fight the Insurer’s Determination That I’m Not Catastrophically Impaired?

On January 15, 2021, Ms. Mohammed was a pedestrian involved in a motor vehicle accident that left her with a mild traumatic brain injury, an L5 transverse process fracture, pelvic fractures, urinary incontinence, sleep impairments, and headaches. After exhausting her policy limits of $65,000.00 for medical, rehabilitation, and attendant care benefits, she sought a designation of catastrophic impairment from her insurer. Such a designation would increase her policy limits to $1,000,000.00 so that she could access more treatment, therapies, and supports. It would also give her access to benefits she did not already have, like housekeeping benefits and case management services.  

Ms. Mohammed applied under criteria 2 and 6 of section 3.1(1) of the Statutory Accident Benefits Schedule – Effective September 1, 2010, which sets out different paths for meeting the definition of catastrophic impairment. Her accident benefits insurer rejected her application on both grounds, finding that she had not suffered a severe and permanent alteration of a prior structure and function involving one or both legs under criterion 2, and that the combination of her physical impairments resulted in only 35% physical impairment of the whole person, falling short of the threshold of 55% required for criterion 6. 

Singer Kwinter conducted a five-day hearing at the Licence Appeal Tribunal (“LAT”) in October 2025, disputing both grounds of denial. On February 10, 2026, the LAT found that Ms. Mohammed had indeed sustained a catastrophic impairment under both criteria 2 and 6, preferring the evidence of Ms. Mohammed’s experts over that of the insurer’s experts. The LAT agreed that the injuries to her pelvis, hips, knees, and ankles constituted a severe and permanent alteration of a prior structure and function involving both legs and that she exceeded the criterion 6 threshold with a physical impairment rating of 64%.  

Catastrophic impairment determinations are often aggressively contested, even where the medical evidence is compelling. This decision underscores the importance of comprehensive medical evidence and strategic advocacy in these disputes.  

If you are facing a denial of accident benefits, experienced legal guidance can make a critical difference. Contact us for a free consultation.