Do I Qualify for Accident Benefits
In Ontario, certain accident benefits must be provided under every motor vehicle insurance policy. Even if you were injured outside of Ontario, you may still qualify for accident benefits. However, you do not automatically qualify for accident benefits from your insurance company following a car accident. In fact, each type of accident benefit that you may be entitled to has its own qualifying criteria.
This article briefly outlines when you may qualify for accident benefits. This article does not provide a comprehensive list of qualifying criteria nor does this article address all accident benefits to which you may be entitled. You should contact a qualified car accident lawyer for a complete assessment of your case and the accident benefits to which you may be entitled.
Available Benefits
There are three categories of injury: catastrophic, non-catastrophic and minor injury. The benefits which you may receive will depend on your category of injury. The level of benefit will also depend on whether you purchased increased optional benefits. For the purposes of this article, we will only refer to regular benefit levels. we recommend reading our article 'Recent changes to Accident Benefits' to keep up to date on some new updates.
Most insurance companies will automatically categorize your injuries as minor even if your injuries are more serious. If your insurance company has told you your injuries are “minor”, you should contact a qualified car accident lawyer for a complete assessment of your case.
Income Benefits: You must choose one of the three following benefits. Since September 1, 2010, the choice can only be made once except in one very limited circumstance.
Income Replacement Benefits: When you have been injured in a car accident and are unable to work as a result of your injuries, you may qualify for Income Replacement Benefits. If you were (1) working at the time of the accident, (2) unemployed at the time of the accident, but employed for 26 weeks during the past year, (3) unemployed and receiving Employment Insurance at the time of the collision, or (4) were self-employed, you may qualify for this benefit.
For the first two years, you must suffer a substantial inability to perform the essential tasks of your employment or self-employment as a result of your injuries to qualify. Afterwards, you must suffer a complete inability to engage in any employment or self-employment for which you were reasonably suited by education, training or experience. This benefit is not payable for the first week.
This benefit does not replace all of your income. For the first two years, you are entitled to 70% of your gross income to a maximum of $400.00 per week. After two years, the law adds a minimum to this benefit of $185.00 a week. The income you earn after the collision may be deducted from the benefit your insurance company has to pay. The insurance company may also deduct some benefits you receive from other sources in some circumstances.
Non-Earner Benefits: When you have been injured in a car accident, but you do not qualify for an income replacement benefit you may be entitled to payments for non-earner benefits. For example, if you were retired, enrolled full-time in school, or had recently completed schooling but had not yet found a job in your field, you may qualify for this benefit. This accident benefit is for people who suffer a complete inability to carry on a normal life as a result of the collision within two years of the collision.
This benefit provides payment of $185.00 a week for your life. In the case of students, this amount increases to $320.00 a week in certain circumstances.
Caregiver Benefit: This benefit is intended to be paid to injured persons who are the unpaid primary caregiver of children or mentally or physically incapable persons, who as a result of the injuries suffered in the collision, can no longer perform those caregiving activities. You must have suffered a catastrophic impairment and a substantial inability to engage in caregiving activities in which you engaged at the time of the collision within two years. After two years, you must suffer a complete inability to carry on a normal life.
These benefits pay for expenses incurred for the care you are unable to provide to a maximum of $250.00 per week plus $50.00 a week for each additional person you cared for.
Housekeeping and Home Maintenance Benefits: When you have been injured in a motor vehicle accident you may be entitled to a housekeeping and home maintenance benefit. This benefit pays for reasonable and necessary additional expenses incurred by you or on your behalf as a result of an accident for housekeeping and home maintenance services. To qualify for payment of this accident benefit, you must suffer a catastrophic impairment that results in a substantial inability to perform the services that you normally performed prior to the accident. Depending on your case, you might be reimbursed for expenses actually paid (i.e./ molly maid, lawn care, pool care, etc.), but also the time spent by unpaid friends and family. This accident benefit is for persons who incur housekeeping and home maintenance expenses they would not otherwise have incurred if not for the injuries suffered in the accident.
If you suffered a catastrophic injury, you may be entitled to $100.00 per week for your lifetime. If you did not suffer a catastrophic injury but purchased optional benefits, you may still qualify for this benefit.
Attendant Care Benefits: When you have been injured in a motor vehicle collision and you incur attendant care expenses as a result of your inability to care for yourself, you may be entitled to an attendant care benefit. Attendant care benefits may be paid for reasonable and necessary expenses incurred for care provided by family members, friends, hired aides or attendants, or by a long-term care facility or chronic care hospital.
If you suffered a non-catastrophic injury, you may receive $3,000.00 a month for two years to a maximum of $36,000.00. If you suffered a catastrophic injury, you may receive $6,000.00 a month for your lifetime to a maximum of $1,000,000.00.
Medical and Rehabilitation Benefits: When you have been injured in a motor vehicle collision and a doctor, medical caregiver or treating health practitioner like a physiotherapist proposes that you require treatment as a result of that collision, then you may be entitled to medical and rehabilitation benefits. These accident benefits pay for reasonable and necessary expenses incurred by you or on your behalf:
- for treatment (such as physiotherapy, and chiropractic, required as a result of the collision), medications (prescription and non), transportation to appointments, assistive devices (such as wheelchairs, crutches, and other devices), and ‘other goods and services of a medical nature’ not otherwise provided in the SABS; and,
- in undertaking activities and measures that are reasonable and necessary to reduce or eliminate the effects of disability or facilitate reintegration into family, society and the labour market, including:
- financial or employment counselling and vocational training;
- family, life skills or social rehabilitation counselling; and,
- home, workplace or vehicle modification.
Measures are considered reasonable and necessary if they enable you to engage in employment similar to the employment engaged in at the time of the collision or lead as normal a work life as possible. Your personal and vocational characteristics must be considered.
If you suffered a non-catastrophic injury, you generally have $50,000.00 available for 10 years. If you suffered a catastrophic injury, you have $1,000,000.00 available over your lifetime. If you have suffered a minor injury, you are limited to $3,500.00 paid out under various treatment blocks.
Other Benefits: There are other benefits available, including:
- Lost Educational Expenses
- Expenses of Visitors
- Damage to Clothing, Glasses, Hearing Aids, etc.
- Death and Funeral Benefits
- In-home Assessments for CAT and Non-CAT patients
Each has its own qualifying tests, restrictions and limitations.
Get help with your Accident Benefit claim
If you have suffered an injury in a motor vehicle collision, including car accidents, pedestrian accidents, single-car collisions, motorcycle accidents, etc, you may be entitled to any or all of the accident benefits mentioned in this article. These accident benefits are provided to you whether you were at fault for the accident or not. If you feel you are entitled to any of these accident benefits but your insurer is denying payment of the accident benefit, let us assist you with your accident benefits claim.