Catastrophic Impairment in Ontario: The Complete 2026 SABS CAT Guide

When a person suffers life-altering injuries in a motor vehicle accident in Ontario, one of the most important legal questions becomes:

“Does this injury meet the definition of a catastrophic impairment under the SABS?”

A catastrophic impairment (often called “CAT”) is the highest classification of injury under Ontario’s auto insurance laws. It dramatically increases the benefits available to an injured person — including access to long-term medical, rehabilitation, caregiver, housekeeping, and attendant care supports.

Yet CAT determinations are complex, heavily technical, and frequently disputed by insurers. This 2026 guide explains, in clear and accurate language:

• what “catastrophic impairment” means under the current Statutory Accident Benefits Schedule (SABS),

• the eight CAT criteria under section 3.1(1),

• how insurers evaluate and dispute these cases,

• how orthopedic injuries and combined impairments may lead to CAT designation,

• what benefits become available after CAT status, and

• when you should consider obtaining legal help.

If you believe your injuries may fall under one of the catastrophic categories, visit our catastrophic injury lawyer page.

Understanding Catastrophic Impairment Under the SABS

The Statutory Accident Benefits Schedule (SABS) defines what counts as a catastrophic impairment in Ontario.

Under section 3.1(1), injuries are considered catastrophic if they fall within any one of eight categories. These categories cover:

• spinal cord injuries,

• severe mobility or limb impairments,

• vision loss,

• adult traumatic brain injuries (TBI),

• child TBIs,

• 55% whole person impairment,

• combined physical and psychological impairment reaching 55% WPI, and

• severe mental and behavioural disorders that significantly impair functioning.

A person needs to meet only one category to be designated catastrophically impaired.

Why Catastrophic Status Matters So Much

For non-catastrophic injuries, benefits are capped at:

• $65,000 total for medical, rehabilitation, and attendant care supports,

• a maximum of five years of funding (with exceptions for minors).

For people with life-altering injuries — spinal cord damage, severe brain injuries, complex fractures, chronic pain syndromes, major psychological impairments — $65,000 is rarely sufficient.

A catastrophic impairment designation may unlock:

• up to $1,000,000 in medical and rehabilitation benefits (policy-dependent),

• expanded attendant care funding,

• renewed access to caregiver benefits,

• access to housekeeping and home maintenance benefits,

• long-term rehab and supportive care,

• significantly greater long-term stability.

These benefits can change the course of a person’s recovery and their quality of life.

The Eight Catastrophic Impairment Categories Under the SABS (2026)

Below is a clear explanation of the eight catastrophic criteria exactly as they appear under O. Reg. 34/10, s. 3.1(1), but written in accessible language.

1. Paraplegia or Tetraplegia

A person may be catastrophically impaired if they suffer:

• paraplegia (loss of movement/sensation in the lower body), or

• tetraplegia (loss of movement/sensation in all four limbs), and their symptoms meet certain thresholds related to:

• neurological level of injury,

• motor and sensory function,

• permanence of deficits,

• reliance on mobility devices,

• overall reduction in independence.

These cases almost always require spinal cord imaging and assessments from specialists such as physiatrists and neurologists.

To learn more about spinal cord injury claims, visit our spinal cord injury lawyers page

For long-term recovery resources, injured people often access support from Spinal Cord Injury Ontario (SCIO)

2. Severe Impairment of Ambulatory Mobility or Use of an Arm, or Amputation

This category applies where an accident causes:

• amputation of an arm or a leg, or

• permanent and significant loss of function in an arm, or

• a severe and long-term inability to walk independently.

This can occur with:

• traumatic amputations,

• permanent nerve injuries,

• major joint destruction,

• severe pelvic or lower-limb fractures,

• permanent upper-limb dysfunction.

These injuries often require extensive orthopedic management and long-term rehabilitative care.

3. Loss of Vision in Both Eyes

A person may be catastrophically impaired if they suffer:

• permanent loss of vision in both eyes, or

• specific thresholds of visual acuity or visual field loss,

even after corrective lenses or medical intervention.

This category is based on measurable ophthalmologic criteria.

4. Traumatic Brain Injury in an Adult (18+) Meeting SABS Criteria

A traumatic brain injury (TBI) in an adult may be catastrophic if:

• CT or MRI imaging shows intracranial pathology consistent with trauma, and

• the person demonstrates a certain level of disability on recognized outcome scales (e.g., the Glasgow Outcome Scale – Extended (GOSE)) at defined time points after the accident.

Functional limitations—such as difficulty thinking, memory issues, behavioural changes, or impaired judgment—are heavily considered.

For additional support resources, many brain injury survivors rely on the Ontario Brain Injury Association (OBIA)

5. Traumatic Brain Injury in a Child (Under 18) Meeting Child-Specific SABS Criteria

Children are assessed differently because TBIs can interfere with development. A child may be catastrophically impaired if:

• they sustained a serious TBI and were admitted to a designated trauma or rehab centre, or

  
  

• they demonstrate impairments at specific follow-up time points (e.g., 6 months, 9 months, 2 years) on validated pediatric outcome scales.

Assessors consider milestones, school performance, behaviour, cognitive development, and long-term functional expectations.

Learn more at our Ontario Brain Injury Lawyers page.

6. Physical Impairment (or Combination of Physical Impairments) Resulting in 55% or More Whole Person Impairment (WPI)

Under the SABS, a person may be catastrophically impaired if their combined physical impairments amount to 55% or greater whole person impairment, as measured using the AMA Guides to the Evaluation of Permanent Impairment (4th edition).

This category often applies to people with:

• multiple fractures,

• spinal or nerve damage,

• chronic pain layered on structural injuries,

• long-term loss of range of motion,

• significant gait abnormalities,

• extensive orthopedic hardware.

Complex trauma cases frequently trigger this category, especially when several regions of the body were injured.

Orthopedic Injuries and Whole Person Impairment (WPI)

Although orthopedic injuries are not a standalone CAT category, they often play a major role in meeting the 55% WPI threshold or in contributing to other catastrophic criteria.

For example, someone with:

• multiple long-bone fractures,

• pelvic fractures,

• significant surgical hardware,

• long-term chronic pain,

• reduced mobility, and

• loss of limb function

may reach catastrophic thresholds once all impairments are combined under the AMA Guides.

Motorcycle collisions, in particular, frequently involve complex orthopedic trauma. To learn more about these cases, visit our motorcycle accident lawyers page.

7. Mental or Behavioural Impairment Combined With Physical Impairment Resulting in 55% WPI

Even when physical impairment alone does not reach 55%, the combination of:

• psychological injuries (depression, PTSD, anxiety disorders),

• chronic pain, and

• physical impairments

may push a person over the threshold.

This category acknowledges the interplay between physical and psychological symptoms. Assessors use structured clinical tools and AMA methodologies to determine the final combined impairment.

8. Mental or Behavioural Disorder Causing Marked or Extreme Impairment

A person may be catastrophically impaired if they suffer a psychiatric condition that causes either:

• Class 4 (marked) impairment in three or more areas of function, or

• Class 5 (extreme) impairment in one area,

such that they are essentially unable to function usefully in daily life or work settings.

Functional domains include:

• social functioning,

• activities of daily living,

• concentration, persistence, and pace,

• adaptation to work-like environments.

This is most often seen in severe PTSD, major depressive disorder, or other debilitating psychological conditions after trauma.

Illustrative Examples of How CAT Criteria May Apply

These examples are hypothetical and meant only to help explain how catastrophic impairment assessments may work.

Example 1 – Orthopedic and Neurological Injuries After a Motorcycle Collision

A motorcyclist suffers multiple fractures, pelvic instability, nerve damage, and chronic neuropathic pain. After rehabilitation, specialists determine their combined impairments may meet or exceed 55% whole person impairment, meaning they may qualify as catastrophically impaired under the WPI category.

Example 2 – Severe Psychological Injury After a Crash

A passenger develops severe PTSD and major depression. They cannot leave their home without assistance, cannot return to work, and struggle to perform daily activities. Structured psychiatric assessments indicate marked impairment across several functional domains. They may qualify under the mental/behavioural catastrophic category.

Example 3 – Child With Traumatic Brain Injury

A child suffers a TBI and is admitted to a designated pediatric rehab centre. Months later, they show cognitive regression and behavioural difficulties. Based on child-specific outcome criteria under the SABS, they may qualify as catastrophically impaired.

How the Catastrophic Determination Process Works

Obtaining catastrophic status involves:

• Completion of an OCF-19 by a qualified health professional,

• Medical imaging (CT, MRI),

• Neuropsychological testing,

• Psychiatric and psychological assessments,

• Occupational therapy functional evaluations,

• Application of AMA Guides methodologies,

• Insurer-arranged examinations (IEs),

• Possible hearings before the Licence Appeal Tribunal (LAT).

The process is evidence-heavy, and insurers often challenge:

• imaging interpretation

• causation,

• chronic pain diagnoses,

• psychiatric ratings,

• combined WPI calculations,

• permanence and prognosis.

Because the stakes are high, insurers frequently resist catastrophic designation.

Benefits Available After Catastrophic Status Is Approved

A person deemed catastrophically impaired may access:

• up to $1,000,000 in medical and rehabilitation funding (policy-specific),

• attendant care benefits at higher lifetime limits,

• caregiver benefits,

• housekeeping and home maintenance benefits,

• access to long-term psychological and rehabilitation services,

• mobility and accessibility devices,

• extensive in-home supports,

• modifications to home and vehicle environments.

These benefits can dramatically improve the injured person’s recovery, independence, and long-term stability.

How CAT Status Interacts With Long-Term Disability (LTD) Claims

Many people who meet catastrophic criteria also face challenges with long-term disability insurers.

LTD insurers may:

• argue that the person does not meet “total disability”,

• rely on their own medical assessments,

• question psychological or chronic pain-related disabilities,

• use surveillance or functional evaluations,

• demand return-to-work attempts.

CAT status does not automatically guarantee LTD entitlement, but it is often strong supporting evidence that the injuries are severe and long-term.

For LTD guidance, visit our long-term disability lawyers page.

How Foster Injury Law Helps With Catastrophic Impairment Cases

Our firm assists clients by:

• identifying which CAT categories may apply to their injuries,

• coordinating appropriate medical and psychological assessments,

• gathering and organizing medical evidence,

• preparing and submitting OCF-19 applications,

• responding to insurer examinations and disputes,

• pursuing LAT hearings when necessary,

• ensuring concurrent tort and accident-benefits claims are aligned.

We represent clients throughout:

• Barrie, Innisfil, Orillia, and Muskoka,

• Kitchener, Waterloo, and Cambridge,

• Vaughan, Newmarket, Richmond Hill, and Ontario.

When You Should Consider Seeking Legal Help

You should speak with a lawyer if:

• your injuries have significantly changed your life or independence,

• your treatment providers believe CAT criteria may apply,

• your insurer is minimizing your injuries or delaying decisions,

• you are overwhelmed with assessments or documentation,

• you cannot function independently or return to work,

• you are facing both accident-benefits and LTD disputes,

• your benefits are running out but your injuries remain serious.

The difference between catastrophic and non-catastrophic benefits can determine the entire trajectory of a person’s recovery.

If you need help, visit our Catastrophic Injury Lawyer Page