Accident Benefit Claims
General Information
Can I apply for accident benefits if I do not own a car and I am not insured under any auto policy?
Types of Benefits
How do I make a claim for accident benefits?
Accident Benefit Links
1. General Information
If you are injured in an automobile accident, you may be entitled to certain benefits from your own car insurance company or from the car insurance company of another vehicle involved in the accident, regardless of who is at fault. Your insurance company will provide you with application forms and will assist you in completing the forms. However, it is quite common for you and your insurance company to disagree about the benefits that should be paid to you. The accident benefits legislation is quite compicated. It is your responsibility to obtain the benefits you need. Click here for a FREE CASE EVALUATION.
2. Can I apply for accident benefits if I do not own a car and I am not insured under any auto policy?
Yes you can. The accident benefits legislation is designed so that you should always have access to some insurer for accident benefits. For example, if you do not own a vehicle and you are not insured under any policy, you can apply to the insurer of the car you were in at the time of the accident. If you were a pedestrian, you can apply to the insurer of the car that hit you.
Every driver is obliged to have auto insurance. Therefore, it is very rare that every car involved in an accident will be uninsured. However, even in this situation, you can apply for benefits to the Motor Vehicle Accident Claims Fund. The Ontario government maintains this fund.
3. Types of Benefits
The benefits you are entitled to depends on the specific facts of your case. What follows is a list of potential benefits:
Weekly benefits
Medical and rehabilitation benefits
Attendant care benefits
Death benefits
Other available benefits
Catastrophic Impairment
You may have increased entitlement to accident benefits if you purchased additional, optional coverage with your auto insurer.
You may have questions about benefits to which you may be entitled. Click here for a FREE CASE EVALUATION.
a. Weekly benefits
i) Income Replacement Benefits
if you are unable to work because of injuries sustained in a motor vehicle accident, you may be entitled to income replacement benefits. The benefit is 70% of your net income, to a maximum of $400.00 per week unless you have optional coverage.
the amount of benefit payable will be generally reduced by other income benefits being received (for example, short term disability or long term disability payments).
income replacement benefits start one week after a car accident that has caused you a "substantial inability" to perform the essential tasks of your employment.
to receive income replacement benefits beyond 104 weeks, you must prove that you suffer "a complete inability to engage in any employment for which you are reasonably suited by education, training or experience".
the amount of the income replacement benefit is reduced after age 65.
ii) Non-Earner Benefits
if you are not employed at the time of the car accident, you may be entitled to a non-earner benefit of $185.00 per week. You must prove that you have suffered a “complete inability to carry on a normal life”.
non-earner Benefits are payable 26 weeks after your car accident.
you are not entitled to receive non-earner benefits if you are under 16.
if you were in school at the time of the accident, you may be entitled to $320.00 per week after the 104 week anniversary of the accident..
iii) Caregiver Benefits - If Purchased as Optional Coverage
If, at the time of the accident, you lived with a person who required care, you may be entitled to a caregiver benefit of up to $250.00 per week, plus $50.00 for each additional person requiring care and you were the primary caregiver.
iv) Election of Benefits
In some cases, you may meet the test for income replacement benefits, non-earner benefits and/or caregiver benefits. If so, your insurance company will require you to “elect” (i.e. choose) which benefit you wish to receive.
b. Medical and rehabilitation benefits
Assuming you can prove entitlement, the accident benefits insurer is required to pay for a wide range of medical and rehabilitation expenses over and above what is paid by OHIP. If you have not sustained a “catastrophic impairment”, the insurer is obliged to pay up to $50,000.00 for up to 10 years after the accident. If you have sustained a catastrophic impairment, the insurance company is obliged to pay up to $1 million over your life.
c. Attendant care benefits - If Purchased Optional
The accident benefits insurer is also required to pay for personal care services that you may require following your accident to a maximum of:
$36,000.00, or $3,000.00/month for up to 2 years, if you have not sustained a catastrophic impairment; or
$1,000,000.00, up to $6000 per month, over your lifetime, if you have sustained a catastrophic impairment.
d. Death benefits
If someone is killed in a car accident, a variety of benefits are payable to a spouse, dependants, persons on whom they were dependant, and others in amounts up to $25,000.00 and $10,000.00.
e. Other available benefits include the following:
Expenses of family members and/or those living with the injured person who visit during treatment or recovery. These may include meals, mileage, travel expenses and accommodation expenses. Please remember to keep your receipts.
Housekeeping and home maintenance expenses, up to $100.00/week, payable for:
up to two years, if you have not sustained a catastrophic impairment, and for life, if you sustained a catastrophic impairment.
Lost education expenses for students, to a maximum of $15,000.00
f. Catastrophic Impairment
“Catastrophic impairment” is a defined term reserved for individuals who have been severely injured. If you can prove that you have sustained a “catastrophic impairment”, you may be entitled to greater benefits, payable for longer periods of time. There are various definitions of catastrophic impairment, including quadriplegia, paraplegia, amputation of both arms or legs, brain impairment defined by a score of 9 or less on the Glasgow Coma Scale, marked or extreme mental or behavioural impairment, and 55% whole body impairment. This is a complex issue. Click here for a FREE CASE EVALUATION.
4. How Do I Make a Claim for Accident Benefits?
Advise your insurance company about your accident immediately, and in any event within 7 days of the accident. Otherwise, you may risk delays in treatment and receipt of benefits.
Complete the forms provided by your insurance company. Click here for a FREE CASE EVALUATION.
provide any necessary forms your insurance company gives you to third parties such as your employer and your treating doctors or health care professionals.
5. Accident Benefit Links
Accident benefit forms can be obtained at:
http://www.autoinsurancereforms.on.ca/fillable_forms.asp; and
http://www.fsco.gov.on.ca
Manuals to assist you in completing accident benefit forms can be found at
http://www.autoinsurancereforms.on.ca/manual.asp