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Sadly, Insurance Limits Are Never Enough to Compensate Spinal Cord Injury Victims

By Matt Lalande in Spinal Cord Injuries on February 03, 2021

Sadly, Insurance Limits Are Never Enough to Compensate Spinal Cord Injury Victims

Traumatic spinal cord injuries are no doubt debilitating injuries that have a life-long impact on both injured victim and their families. Beside the physical impact of Spinal Cord Injuries, many aspects of daily function are affected, including the ability to work and take part in social and community functions or recreational activities. While you are forced to adjust to an unexpected new life full of emotional and physical limitations, the stress of wondering how you will afford to live or provide for your family can be absolutely overwhelming.  The acute or initial costs, along with the recurring annual costs of caring for victims with a traumatic chronic spinal cord injury (SCI) is a large economic burden that is staggering.

Motor Vehicle Insurance Limits in Ontario

There are third party limits (i.e. the motorist’s insurance policy of the driver that hit you)  and first party limits – your own insurance policy that provides what we call accident benefits.

While every province in Canada requires drivers to maintain a certain amount of car insurance coverage, in Ontario, motorists are required to purchase minimum limits of $200,000.00 – however –  most insurance brokers will not even sell coverage this low to their clients. Most, if not all brokers require their clients to purchase at least $1,000,000.00 in coverage. Trucking policies in Ontario normally contain liability limits that range between $2,000,000 and $5,000,000.00.

Your own policy contains “Accident Benefit Coverage” which are benefits that you or other insured persons may receive in injured or killed in a motor vehicle accident. These benefits are  listed in the Statutory Accident Benefits Schedule.

The Schedule contains 3 tiers – or maximum dollars which can be allocated to victims in a crash. For minor injuries, you are entitled to apply up to $3500.00 in medical/rehabilitation and attendant care benefits.   For non-catastrophic injuries, victims are entitled to apply up to $65,000 in medical/rehabilitation and attendant care benefits. Catastrophically injured victims are entitled to apply up to $1,000,000 in in medical/rehabilitation and attendant care benefits. These benefits can be increased if you have purchased “optional benefit coverage.”

In most (but not all) Ontario motorist cases, a spinal cord injury victim wold most likely recover $1,000,000.00 from the at-fault driver, and another $1,000,000 in medical, rehab and attendance care benefits from their own insurance company. $2,000,000.00 however, is not enough.

Calculating the Financial Burden of a Spinal Cord Injury in Ontario

The cost of a spinal cord injury is divided into two categories: direct cost and indirect cost. Direct cost refers to expenses associated directly with treatment of the injury, such as hospitalization, rehabilitation, medical care, and so on. Indirect cost refers to additional financial burdens the individual will face as a result of the injury, such as lost wages from missed work, housing arrangements, vehicle modifications, and other factors.

Researchers have conducted studies on the financial burden of spinal cord injury in Ontario and Canada, but this research often quantifies direct costs in medical care and does not account for indirect costs that an individual will continue to face over their lifetime. It can be difficult to quantify the indirect costs as each scenario is different, and each patient may face unique or varied circumstances. Additionally, this cost analysis is based on prediction models as the future is uncertain. 

The True Cost of a Traumatic Spinal Cord Injury 

The cost of a spinal cord injury can easily reach $2 million to $5 million over the individual’s lifetime. This depends on the level of injury and extent of the damage. With complete spinal cord injuries, the consequences are generally more severe the higher the level of injury is, and more severe injuries require more long-term or permanent 24 hour care.  When our Hamilton Personal Injury Lawyers retain life care planners, here are some of the services and items that are commonly recommended. 

Medical Costs: A traumatic spinal cord injury victim can face direct costs of up to $1 million in the first year alone. After the first year, annual medical costs can still total hundreds of thousands of dollars depending on the injury and treatment plan. There are also many costs related to medical care that are not covered by OHIP, such as:

  • prescriptions
  • caregiver services
  • travel for out-of-town treatment
  • psychological care
  • occupational therapy
  • recreational therapy
  • vocational therapy
  • nutritional therapy
  • family counseling
  • physical therapy – acute and long-term
  • caregiver costs – what if a parent was hurt?
  • orthotics
  • power in home bed
  • bed ladder
  • lifts
  • no turn mattresses
  • shower equipment
  • adaptive clothing
  • bowel and bladder equipment and care, ect.

Lost Wages: Approximately 35% of traumatic spinal cord injury victims are able to return to work, and therefore accumulate significant lost earning potential. For example, if a 30-year-old individual was making an annual salary of $50,000 before their injury and could not return to work, and had planned to retire at age 65, they would lose approximately $1.75 million solely in missed wages.

Housing Modifications: When a spinal cord injury victim returns home, they often must make modifications to their house in order to make it accessible. This includes installing ramps, modifying bathrooms, expanding doorways, lowering countertops, or installing elevators. All of these renovations can cost tens of thousands of dollars, if not more. 

Modified Vehicles: It is possible for spinal cord injury victims to drive a vehicle independently again. This requires a modified wheelchair-accessible van for full paralysis or vehicle modifications for partial paralysis, which can easily range between $40,000 and $80,000 – not to mention, maintenance costs. Additionally, individuals are required to complete handicap driver training.

Accessible Equipment: Finding the right wheelchair is a source of stress for many spinal cord injury victims, and high-quality wheelchairs often come with a substantial cost that benefits may not always cover. There are also different types of wheelchairs, such as manual wheelchairs, power wheelchairs, roll-in shower wheelchairs as well as associated costs such as maintenance, battery chargers, battery replacement, cushion replacements ect.

The costs listed here are just a snippet of the financial cost that a spinal cord injury victim will face, and in reality there are a variety of other factors involved depending on someone’s lifestyle and location. For example, the cost of each hour of attendant care for a spinal cord injury victims (whether paid or unpaid), based on the national average can be as high as $25.00 + HST per hour. Over the course of someone’s life can be well over $150,000 per year alone. 

The Unfortunate Reality is that in most cases, Insurance Limits Are Simply Not Enough.

The estimated lifetime costs of a spinal cord injury victim ranges based on 1) age and 2) the severity of injury. For examples, The Reeves Foundation published statistics (albeit in 2014) which showed that the lifetime cost of spinal cord injury victims who suffered from high tetraplegia (C1-C4) ASIS ABC ranged between (USD) $2,596,329 and $4,724,181. (in CDN between $2,596,329 and $6,044,849.16).  The costs of lifetime care over a victim that suffered an incomplete motor function ranged between (USD) $1,578,274 and $1,113,990. (in CDN between $2,019,139.41 and $1,425,165.16).

These published numbers relate to the cost of care only – and not compensation for lost wages over the person’s lifetime. These numbers also do not include compensation for pain and suffering, the loss of housekeeping capacity, or an award for family members who have also suffered emotionally and economically.

Insurance limits in Ontario are simply not high enough to compensate a spinal cord injury victim for the financial burden they will experience over their lifetime.

There are some resources available depending on where you live that can provide funding for spinal cord injury victims and access to certain resources you will need. Spinal Cord Injury Ontario is a helpful organization that has regional offices that can connect you to support groups, funding, and other services.

However, no matter how much local support you can find, you are likely still going to be living with the substantial cost of your injury – and to make matters worse, Insurance companies in Ontario will still look for every discount they can when paying limits on a claim. Insurance companies are NOT in the business of handing out settlements without a discount.

Contact our Spinal Cord Injury Lawyers

We understand that no financial dollar amount is ever going to make up for the amount of physical and emotional suffering and devastating circumstances you have been forced to endure. However, receiving a fair settlement in a personal injury claim will allow you to alleviate as much of the financial burden as possible.

Matt Lalande has worked closely with traumatic spinal cord injury victims in Ontario since 2003, and understands how complicated, multidimensional, and frustrating the post-injury process can be. There are a variety of factors to consider when filing a claim, and the team at Lalande Personal Injury Lawyers have many years of experience reviewing and analyzing these factors to determine the best possible settlement to claim. 

Book a free consultation to go over your case details and determine the amount of compensation you are rightfully owed. All consultations are free, with no obligation to retain our services, and we do not collect any fees until you win your case. Call us province-wide at 1-844-LALANDE (525-2633), locally at 905-333-8888, or fill out our online form to request a call back within 24 hours.

1 King Street East, Suite 1705

Hamilton, On L8P 1A4

*The above information was approved by Matt Lalande or another lawyer at Lalande Personal Injury Lawyers. The information comes from legal experience, trial experience, extensive medical research and discussion with medical professionals, medical journal review and updates and/or consultations with fellow friends and colleagues in the legal and medical field.



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