Overview

The entire landscape of Statutory Accident Benefits changed in Ontario on September 1, 2010. Here is a summary of the new regulations and benefits available:

Anyone injured in a motor vehicle accident, whether a driver, passenger, pedestrian or cyclist is entitled to receive Accident Benefits in Ontario. These benefits are available regardless of whether the victim is at fault or not at fault, as Ontario has a no-fault insurance system. However, almost every benefit available except for medical rehabilitation will be denied if the victim was doing something illegal at the time of the accident, including but not limited to:

–          Driving while impaired

–          Driving without consent from the vehicle’s owner

–          Driving without a valid driver’s license

–          Any type of criminal activity

You must notify your insurance company that you have been in an accident within 7 days of the accident, and the forms relating to your claim must be sent in within 30 days of receiving them. This is why it is extremely important not to delay and to speak with a personal injury lawyer immediately following your accident.

Benefits

Although you can elect to purchase additional accident benefits coverage, the following benefits are standard with all Ontario insurance policies.

Income Replacement

If you are unable to return to work due to injuries sustained in your motor vehicle accident, you may be eligible to receive income replacement. You must be employed and have worked at least 26 of the 52 weeks preceding the accident.

You may be eligible to receive 70% of your pre-accident income (gross income before taxes) up to a maximum of $400 a week for a maximum of 104 weeks after the accident. If you are self-employed, different calculations come into play but the amount will usually be based on your average income over the 52 weeks preceding the accident.

Non-Earner Benefit

If you do not qualify for Income Replacement, you may qualify for the Non-Earner Benefit if you suffer a “complete inability to carry on your normal life”. This standard is fairly difficult to meet, but if met, you may qualify for $185 per week which can be kicked up to $320 after 104 weeks if you still meet the disability test.

Caregiver Benefit

If you have suffered a catastrophic impairment and you were the primary caregiver of a child or adult in need of care, you may qualify for $250 per week for the first person under your care and $50 per week for each additional person. Unless you have purchased additional insurance, this amount is only payable for 104 weeks after the accident.

Death and Funeral Payments

The spouse of a person who dies in a motor vehicle accident may be entitled to $25,000 for funeral expenses. A person who was dependent on the deceased may receive $10,000.

Medical Rehabilitation

If you were injured as a result of a car accident, you are eligible to receive coverage for expenses relating to all medical and rehabilitation costs. These may include hospital costs, medication, physiotherapy, chiropractic, assistive devices (hearing aids, eyeglasses…) and a bevy of other medical services that are not otherwise covered for the victim. In the new regulations, injuries are classified in three categories: minor injuries, non-minor injuries and catastrophic injuries. It is beyond the scope of this article to give a detailed explanation of which types of injuries fall in each category. What is important to know is that a minor injury falls under the Minor Injury Guideline and limits all rehabilitation benefits payable to a total of $3,500. For a non-minor injury, the limit is $50,000 and for a catastrophic injury, it is $1,000,000.

The difficulty which we as personal injury lawyers in Ontario have faced since the new regulations is dealing with the Minor Injury Guideline. As you can imagine, $3,500 does not go a long way for a victim of a motor vehicle accident, particularly when that figure also includes cost of examinations which can range up to $2,000 each.

Attendant Care

If, due to the motor vehicle accident, you are no longer able to take care of yourself and are in need of an aide for certain basic needs such as grooming and bathing, you may qualify for Attendant Care Benefits.

If you have suffered a non-minor injury, you may be eligible to receive up to $3,000 per month in Attendant Care up to a maximum of $36,000 in a 104-week period. If your injury is catastrophic, those figures increase to $6,000 per month up to $1,000,000 with no time limit.

Transportation

We are often asked whether or not the insurance company will cover transportation costs to physiotherapy. These costs will only be covered if the distance to the clinic is more than 50 kilometres and only for the amount in excess of 50 kilometres. This restriction does not apply if the injury is catastrophic.

Other Expenses

Tuition Expenses: If at the time of the accident you were enrolled in an education program and can no longer continue said program due to your accident-related injuries, you may qualify for a reimbursement of up to $15,000 in expenses.

Visitor Expenses: Typically the insurance company will cover all reasonable expenses incurred by family members while visiting the injured party, so make sure to keep all your hospital parking receipts.

Housekeeping: Under the new regulations, housekeeping benefits are only available to victims who have suffered catastrophic injuries and are limited to $100 per week.

This is a simple, non-detailed overview of the new Accident Benefits system in Ontario. If you were injured in a motor vehicle accident, call a personal injury lawyer mississauga immediately at Intraligi Law Firm by dialing 1-855 448 4277.