Accident Benefits - What's Available?

The various classifications of claimant (see What kind of Accident Benefit claimant are you?) affect your entitlement to the following benefits. It is possible to purchase additional benefits when renewing your insurance policy, but the following descriptions only address the baseline benefits that are provided as part of every policy of motor vehicle insurance in Ontario. It is always prudent to check your policy to see if you purchased benefits that exceed the statutory minimums described below.

Medical And Rehabilitation Benefits

These benefits are crucial to our injured clients because they pay for the reasonable and necessary medical and rehabilitation expenses that are not covered by a government or private health plan that may be available to them. For those classified as minor injury claimants, the limit on this benefit is $3,500. For non-catastrophic claimants, there is a limit of $50,000 ($100,000 for accidents falling under the old regulations) which is available for 10 years following the date of the accident. For those catastrophically injured, having been deemed catastrophic as defined in the schedule, the amount of medical and rehabilitation benefits is increased to $1 million and is available to you for your lifetime.

Attendant Care Benefits

If you are unable to carry on with your own personal care following an accident, then attendant care benefits will pay for the reasonable and necessary expenses of an aide, attendant or long-term care facility. These benefits are not available to those classified as minor injury. For those classified as non-catastrophically injured, the attendant care benefit shall not exceed $3,000 per month, up to 104 weeks or a total maximum of $32,000 ($72,000 for accidents falling under the old regulations). However, if your injury is catastrophic, available Attendant Care benefits may increase to $6,000 per month, up to a total maximum of $1 million.

Housekeeping Benefits

This weekly benefit, payable to a maximum of $100 per week, is available to Non-CAT claimants falling under the old schedule but is otherwise only available to CAT claimants. Claimants must have sustained an impairment that resulted in a substantial inability to perform the housekeeping tasks regularly performed prior to the accident.

Election Of Benefits

Each accident benefit claim may elect only one of the following three benefits: income replacement benefits, caregiver benefits and non-earner benefits. A claimant may qualify for two of these benefits and will therefore face a choice. It is important to note that for accidents falling under the new schedule, any election that is made is considered to be final. Therefore, it may be prudent to seek legal advice before making any such election.

Income Replacement Benefits (IRB)

This benefit is available if you were employed or self-employed at the time of the accident or for 26 of the 52 weeks preceding the date of the accident. In addition, an accident benefit claimant may qualify for this benefit if he or she was receiving unemployment insurance at that time of the accident. This benefit is payable for two years after the accident so long as you are substantially unable to perform the essential tasks of your employment. The disability test changes at the two-year anniversary of the accident. Income benefits should continue to be paid after two years as long as you are suffering a complete inability to engage in any employment for which you are reasonably suited by education, training or experience. Income replacement benefits are paid on a weekly basis calculated at 70 percent of your pre-accident gross income, up to a maximum of $400 per week.

Non-Earner Benefits

If you were unemployed at the time of the accident and don't otherwise qualify for an income replacement benefit, you may qualify for what is called a non-earner benefit. A non-earner benefit is typically paid at the rate of $185 per week and in some instances $320 per week. You are not entitled to any non-earner benefit for the first six months following an accident. However, if after the first six months you suffer a complete inability to carry on a normal life thereafter, within two years of the date of the accident you will become entitled to a minimum non-earner benefit.

Caregiver Benefits

If you have been deemed to be a CAT claimant, were a caregiver at the time of the accident and are unable to carry on your caregiving activities, you are entitled to receive the reasonable costs of paying for professional care to a maximum of $250 per week plus $50 for each additional child or dependant.

Death Benefits

A death benefit of $25,000 is payable to the deceased's spouse and $10,000 to each dependant and to any person the deceased was legally obliged to provide regular support for. If there is no spouse in the picture, then an additional $25,000 is available to be equally divided amongst dependants and persons legally entitled to support payments from the deceased.

Funeral Benefit

Funeral expenses are paid to a maximum of $6,000.

Incurred Expenses

Under the new schedule, attendant care benefits, housekeeping benefits and caregiver benefits must be provided by a professional service provider, like a babysitter, cleaner or a nurse. Only then will the insurer be required to pay. Generally speaking, this prohibits family members from receiving payment for performing these activities, something which was permissible under the older schedules. Exceptions do exist, and it would be advisable to discuss these with an experienced Accident Benefits lawyer.

Miscellaneous Benefits

In addition to the above, there is provision in the schedule to provide compensation or payment for the cost of medical assessments, medical reports, transportation to medical appointments, the cost of preparing an accounting report for self-employed persons seeking income replacement benefits, the cost of utilizing a qualified case manager to assist with your claim, lost educational expenses, visitor expenses while in hospital, and compensation for clothing and medical devices damaged in the accident.