Statutory Accident Benefits Time Periods

In Ontario, when you have suffered a motor vehicle accident, whether a car accident, motorcycle accident, truck accident, or other accident covered by your motor vehicle insurance, you are entitled to receive certain payments (called ‘accident benefits’) from your own insurance company that are intended to help you recover from or manage your injuries. You need to be aware that there are Accident Benefits time periods. There are specific steps within certain timelines you must meet in order to be entitled to receive accident benefits relating to your injuries.

When in a motor vehicle accident, in order to meet the accident benefits time periods, you must notify your insurer that you intend to apply for an accident benefit within seven days after the accident. If you don’t notify the insurer within that time period, your insurer may delay payment of your accident benefits. To apply you must submit a completed application for accident benefits to the insurer within 30 days after receiving them. Your insurer should provide you with the appropriate application forms.

It is important to know that your insurer is required to provide you with payment or refuse the accident benefits within certain timelines provided you have supplied the insurer with the properly completed applications, information, and treatment plans.

The chart below describes some types of accident benefits available and the insurer’s obligations to you. It also lists the timelines the insurer must meet their obligations according to the relevant legislation and regulations in Ontario.

Accident Benefits Time Periods

Type of Benefit	Insurer’s Obligation	Time Period
Death Benefit	Pay the death benefit for an insured who dies as a result of a motor vehicle accident	Within 180 days after the accident
Medical and Rehabilitation Benefits	Must notify of the devices, services, assessments, and examinations (described in a treatment plan submitted by your medical provider) that the insurer agrees to pay or refuses to pay and the reasons. Pay expenses the insurer has notified it will pay without the requirement for submission of a treatment plan	Within 10 days after receiving the treatment plan/assessment 30 days after receiving the invoice
Attendant Care Benefits	Must give notice to the injured insured advising which attendant care expenses the insurer agrees to pay and reasons and must pay attendant care benefits	Within 10 days after receiving the assessment of attendant care needs

***The above chart is intended as a general guideline only. The accuracy of the chart is not guaranteed. You should contact a lawyer at Murray Ralston Lawyers to obtain legal advice specific to your situation.

If a benefit is denied, an insured person has the right to commence mediation to resolve the dispute. An insured must apply for mediation within two years after the insurer’s denial to pay the benefit. If the application for mediation is made after two years the right to mediate the dispute will be lost. If the results of the mediation are not satisfactory there is a right to arbitration. The application for arbitration must be filed within 90 days of the mediator’s report or the right to arbitrate will be lost.

* The information above is not intended to be legal advice. Each situation is different and the information provided above may not provide you with all law applicable to your facts. To ensure you are properly protected under the law applicable to your facts, please contact Murray Ralston Law for a free consultation.