This area of law is complex and always changing. It is vital that you select an experienced legal team when navigating Ontario Accident Benefit claims.
Effective September 1, 2010, Ontario’s no fault accident benefits, commonly known as the SABS (Full Name: Insurance Act Ontario Regulation 34/10 Statutory Accident Benefits Schedule – Effective September 1, 2010), underwent its most recent significant changes.
If you are injured in an accident involving a motor vehicle, you are entitled to apply for medical, economic, and other benefits. It does not matter who is at fault for the accident. If you are injured because of a car accident, you are entitled to apply, even if you do not have insurance.
The amount and type of benefits available depend on the type of injury. There are three main categories for injuries: minor injuries, catastrophic, and non-catastrophic.
A common dispute with the insurance company and the insurance adjuster is a difference of opinion with respect to the category of the injury. This makes a significant difference in your rights.
The following are the type of benefits that are potentially available to a person injured in Ontario in a motor vehicle accident, or someone who has an Ontario motor vehicle insurance policy but is injured outside of Ontario.
- Financial (you may be entitled to one of the three types of benefits):
- Income replacement benefits – up to a maximum of $400.00 per week unless the insurance policy has optional benefits. You receive this if you were earning income before the accident. This number is calculated by taking 70% of your gross income, commencing one week following the loss for the first two years if you are unable to do your own job, until age 65 if you are unable to do any job
- Non-earner benefits – $185.00 per week ($320 per week if you were in school) beginning 26 weeks after the accident, if you suffer a complete inability to carry on a normal life as a result of and within 104 weeks after the accident.
- Caregiver benefits – if you were responsible for providing care to someone before the accident, but can no longer provide that care, then you may be able to receive $250.00 per week for the first person and $50.00 per week per person after that. This is available for the first two years if you suffer a substantial inability to engage in caregiving activities. After the two years, it is only available if you suffer a complete inability to carry on a normal life. This only applies if you have optional benefits or sustain a catastrophic impairment
- Recovery and Assistance:
- Medical and rehabilitation benefits – covers medical and therapeutic expenses not covered under OHIP. There is a maximum amount available depending upon the severity of the injuries.
- Qualified case manager services – a person is paid to co-ordinate medical, rehabilitation and attendant care benefits.
- Attendant Care benefits – any expenses that you incur due to services provided by a homecare attendant or medical facility in cases where a person sustains a catastrophic impairment.
- Transportation – pays a certain amount per km of travel.
- Housekeeping and Home Maintenance – maximum of $100.00 per week.
- Lost education expenses – up to a maximum of $15,000.00.
- Visitor’s expenses – covers costs incurred by family. There is no financial limit.
- Damage to clothing – this includes clothing, prescription eyewear, dentures, hearing aids, prostheses, and other medical assistive devices damaged in the accident. There is no limit.
- Cost of Assessments, examinations, and writing of reports- maximum of $2,000.00. The costs of these examinations are deducted from the medical and rehabilitation benefit pool of money.
- In-home assessments and examinations – determines necessary assistive devices, attendant care, and housekeeping.
In the event of a death arising from a motor vehicle accident:
- Death benefits include –
- 25,000.00 to a spouse
- $10,000.00 to a supported former spouse
- $10,000.00 per dependent
- $25,000.00 divided equally among dependents, if there is no spouse.
- Funeral benefits – Maximum of $6,000.00
You are eligible to apply for these benefits if you qualify under the law. You may qualify and receive some, all or none of the benefits based on your personal circumstances. Prior to an accident, you are entitled to purchase optional benefits which can modify and increase the amount and type of benefits available.