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Accident Benefits |
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| Accident benefits, or 'no-fault
benefits' are available to any insured person involved
in a motor vehicle accident regardless of who caused the
accident. |
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| In order to protect your
entitlement to accident benefits: |
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 You must notify your insurance
company immediately after the accident (If you do not
have an insurance company, notify the insurance company
of the other vehicle(s) involved in the accident).
You must complete an application for accident benefits
which will be sent to you by your insurer (this includes
form substantiating your income loss which must be
completed by your employer and a form substantiating
your injuries or disability certificate which must be
completed by a treating physician).
If you were self-employed, you must be able to
substantiate your income and may require the assistance
of an accountant.
You will have be asked to provide a statement to a
representative of the insurance company about the
circumstances of the accident and the injuries you
suffered as a result. |
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| The following accident benefits
are available: |
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Loss of income benefit
equal to 80% of your net income from employment, to a
maximum of $400.00 per week.
This income
benefit is payable for two years after the accident so
long as you are substantially unable to perform the
essential tasks of your employment. 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.
If you were
unemployed at the time of the accident, you are not
entitled to any weekly benefit for at least six months.
However, if you suffer a complete inability to carry on
a normal life after six months, you will become entitled
to a minimum non-earner benefit.
If you were a
care giver at the time of the accident and are unable to
carry on your care giving activities, you are entitled
to receive the reasonable costs of paying for
professional care to a maximum of $250 per week plus
$50.00 for each extra child.
Medical and
rehabilitation expenses are generally limited to
$100,000.00. If your injury is "catastrophic" as defined
in the regulations, the amount of medical and
rehabilitation benefits is increased to $1,000,000.00
and is available to your for your lifetime.
Attendant Care Benefits shall not exceed $3,000.00 per
month, up to 104 weeks or a total maximum of $72,000.00.
However, if your injury is catastrophic, available
Attendant Care Benefits may increase to $6,000.00 per
month, up to a total maximum of $1,000,000.00.
Death benefits of $25,000.00
are payable to the deceased's spouse and an additional
$10,000.00 to each of the deceased's dependents.
Funeral expenses are paid to a maximum of
$6,000.00. |
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Request a consultation |
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Catastrophic
Impairment |
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| Generally, "catastrophic
impairment" caused by an accident is defined as: |
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(a) paraplegia or quadriplegia;
(b) the amputation or other impairment causing the total
and permanent loss of use of both arms or both legs;
(c) the amputation or other impairment causing the total
and permanent loss of use of one or both arms and one or
both legs;
(d) the total loss of vision in both eyes;
(e) brain impairment that, in respect of an accident,
results in,
(i) a score of 9 or less on the Glasgow Coma
Scale, according to a test administered within a
reasonable period of time after the accident by a person
trained for that purpose, or
(ii) a score of 2
(vegetative) or 3 (severe disability) on the Glasgow
Outcome Scale, according to a test administered more
than six months after the accident by a person trained
for that purpose;
(f) an impairment or combination of impairments that
results in 55 per cent or more impairment of the whole
person; or
(g) an impairment that results in a class 4 impairment
(marked impairment) or class 5 impairment (extreme
impairment) due to mental or behavioural disorder. |
The Legislature's definition of
"catastrophic impairment" was intended to foster
fairness for victims of motor vehicle collisions by
ensuring that accident victims with the most health care
needs have access to expanded medical and rehabilitation
benefits.
An impairment assessment for a
"catastrophic impairment" can include a combination of
valuations for a variety of injuries, which by
themselves do not meet the definition of catastrophic,
but when summed together exceed the threshold of
catastrophic impairment. The courts have held that the
relevant provision in the Ontario Statutory Accident
Benefits Schedule ("SABS") require a consideration of
all a person's impairments, however caused, including
psychological impairment, and that these impairments be
totalled together in arriving at the whole person
impairment rating. Determination of whether an injury is
catastrophic is important for the determination of
compensation of injuries suffered in automobile
accidents in Ontario.
The foregoing is intended as a
broad summary of some available benefits and is not
intended to be exhaustive. We refer you to the website
of the
Financial Services Commission of Ontario or FSCO,
the government body which regulates the relationship
between you and your own insurance company. A dispute
between you and your insurer may be heard through the
Mediation and Arbitration procedures set forth in the
Statutory Accident Benefit Schedule which may be
reviewed on–line.
With rare exception, your
accident benefit claim will be monitored by the accident
benefit department at our offices. We will assist
whenever necessary in the resolution of disputes between
you and your insurer, in the completion of originating
forms, in the submission of expenses, and in assisting
you to obtain rebuttal medical reports to counter an
unreasonable position taken by an insurer with respect
to the payment of any benefit. The handling of your
accident benefit file in conjunction with your tort
claim must be co-ordinated so as to ensure that you
receive full compensation in both areas.
Because of the inter-play
between tort and accident benefit insurers, disclosure
requirements and the overlapping exposure to pay certain
benefits, it is typically necessary to involve both
insurers in any settlement process which is undertaken
to resolve either or both of your files. Thus, should
settlement by way of private mediation present itself as
a viable option in order to resolve your tort file, the
accident benefit insurer may also be invited to resolve
any outstanding or prospective claims. |
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Request a consultation |
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