Caregivers with cognitive impairments are overrepresented within the child welfare system. Literature in this area is scarce and does not explain factors that influence child welfare system decisions or variation in outcomes. This study is a secondary analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) 2003 data, which has been utilized to explore the relationship between cognitive impairments in caregivers and child maltreatment investigation outcomes (i.e., substantiation of maltreatment, case kept open, child welfare court applications, and placement). Findings suggest that one third of unsubstantiated investigations involving parents with cognitive impairments are transferred to ongoing child welfare services. The most common concern in cases involving parents with cognitive impairments is child neglect. Interestingly, when a referral for in-home parenting support is made, the likelihood of court action is substantially reduced. The study suggests a need for further consideration of how to respond to caregivers with cognitive impairments who are involved with the child welfare system.