Statutory Accident Benefits for Automobile Accidents in Ottawa, Ontario

Statutory Accident Benefits for Automobile Accidents in Ottawa, Ontario

Most people don’t know what forms of assistance they have access to if they have been hurt in a car accident. There are two “schemes” of compensation that govern car accidents in Ontario. The first is the ACCIDENT BENEFITS scheme. If you have been injured, then irrespective of who is at fault, your own insurance company must provide you with accident benefits under the Statutory Accident Benefits Schedule (“SABS”) enacted pursuant to the Insurance Act. Accident benefits include:

• Weekly income replacement benefits, if you are unable to complete the essential tasks of your pre-accident employment.
• Medical benefits, which includes medications, dental services, and prescription eyewear
• Rehabilitation benefits, such as physiotherapy, massage therapy, occupational therapy, assistive devices, and vocational re-training
• Outdoor maintenance, if you can no longer do chores like shovel your driveway or mow your lawn
• Payment for a housekeeper, if you have been catastrophically impaired
• Attendant care, such as private nursing care
• Transportation to and from medical appointments
• Payment of expenses of your visitors and family members

This is not an exhaustive list of the accident benefits that could be available to you. You should also know that you may have to meet certain conditions before the benefits are payable. The nature of your injury may also impact on the type and duration of benefit available to you – for example, if you suffer a whiplash injury, then, depending on its severity, income replacement benefits will only be available to you for 12 to 16 weeks under the “Minor Injury Guideline” (aka the “MIG”).

You must contact your insurance company within 7 days of your accident, and apply for accident benefits within 30 days of your accident.

Your accident benefits insurer has a duty to deal with your claim, and with you, in “good faith.” Technically, the accident benefits insurer is on your side; practically, you may not feel this is the case, particularly when the insurer terminates your income replacement or refuses to pay for another benefit, such as continued physiotherapy. The circumstances under which the insurer will terminate a benefit, and your remedies in response, will vary. You should seek legal advice once the insurer terminates your benefit or does not deal with you in good faith.

1. Medical and Rehabilitation Benefits:

Under the SABS, accident victims are entitled to up to $50,000 of medical-rehabilitation benefits, payable over a 10-year time period, so long as they do not have a “minor injury.” If your insurance company disagrees with a particular rehabilitation expense, such as physiotherapy, for example, they must send you to one of their own medical assessors, to determine if the expense is “reasonable and necessary.”

You can increase this limit to $100,000 if you purchase Optional Coverage.

These limits are even lower for what is called a “Minor Injury.”

2. “Minor Injuries”

Minor Injuries are defined in the SABS as a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any “clinically associated sequelae.”

If you have a “minor injury,” your medical-rehabilitation expense limits are only $3,500.

Unfortunately, you cannot purchase optional enhanced coverage.

3. Income Replacement Benefits (“IRBs”)

Under the SABS, weekly IRBs are calculated as 70% of your gross weekly earnings, up to a maximum of $400 per week. You are entitled to IRBs for the first two years so long as you are unable to perform the duties of your own job. After two years, IRBs will only continue if you are unable to do any job for which you are or may become suitable by education, training or experience.

You can purchase Optional Insurance Coverage to increase the weekly maximum to $600, $800 or $1000.

4. Housekeeping Benefits

Before September 2010, the automobile insurer paid up to $100 per week for those individuals who required housekeeping/homemaking assistance after their accident. They were entitled to this payment for two years after their accident, or, if they sustained a “catastrophic impairment,” indefinitely.

Unfortunately, housekeeping benefits have been eliminated, unless you have sustained a catastrophic impairment.

You may purchase this benefit for an additional premium, which will pay a housekeeping benefit even if you are not catastrophically impaired.

5. Attendant Care Benefits

Attendant Care is often critical for individuals who need supervision and assistance following their accidents and during their convalescence. While severely injured persons often need a nurse or other health care professional, in the vast majority of cases it is family members and friends that provide this service.

Attendant Care benefits are not available for those with a Minor Injury. For other non-catastrophic claims, the maximum amount payable is $3000 per month to a maximum of $36,000 for the first two years after the accident. If you are catastrophically-impaired, the maximum monthly amount is $6,000, up to a lifetime maximum of $1 Million.

WHAT WE CAN DO FOR YOU IF YOU HAVE BEEN INJURED IN A CAR ACCIDENT
Accident Benefits:

• Assist clients with their Accident Benefits application and claims process
• Locate the appropriate rehabilitation and health care professionals (occupational therapists, vocational assessors, psychologists, etc)
• Work very closely with your rehabilitation and health care team to ensure that all aspects of your non-OHIP care is adequately funded
• Ensure that your insurance company treats you in good faith
• If your insurance company denies or terminates any accident benefits funding that may be owing to you, we dispute the denial or termination through the dispute resolution procedure before the Financial Services Commission of Ontario (“FSCO”)
• Investigate and quarterback the process whereby seriously injured persons may be deemed “catastrophically impaired.” This process involves retaining the appropriate medical experts, submitting the requisite forms and documents to the insurance company, and if necessary proceeding with a dispute before FSCO.

The second insurance scheme that governs automobile accident in Ontario is called the tort scheme – or what is commonly known as a lawsuit for damages. I will be posting another article on this scheme shortly!