In 2018, 49,408 people in Ontario were injured in a car accident.1 No matter how safely you drive, if you spend a lot of time in your car, it’s possible you’ll be the victim of a car accident at some point in your life. If you’ve been injured in a car accident, it’s important that you speak to your insurance provider and your medical professionals to assess your injuries and make sure that you’re compensated accordingly.
What Are Accident Benefits?
If you’ve been injured in an accident in Ontario, there are certain financial benefits that may be available to you to help you recover. These are called Statutory Accident Benefits. The Statutory Accident Benefits Schedule (also known as SABS) is a provincial regulation surrounding benefits that are standardized among various insurance companies. These benefits provide compensation if you, your passengers, or a pedestrian suffers any injuries resulting from a car accident. Ontario is a no-fault insurance system; therefore, these benefits are available to everyone involved in the accident, regardless of fault.
Who Can Claim Accident Benefits?
Any person who was injured in a car accident. These accident benefits are also available to certain relatives or dependants who end up suffering psychological or mental injuries because of the accident. So, even if you weren’t involved in the accident, depending on the circumstances, you may still be eligible for accident benefits to help you deal with psychological or mental trauma because of an injured relative.
If you have multiple insurance policies, there are special rules that dictate which policy you’re eligible to receive accident benefits from.
Can My Insurance Deny Payment?
Your insurance company can legally deny payment of Income Replacement Benefits, Non-earner Benefits and compensation for Other Expenses Benefits in certain scenarios. Normally these scenarios involve you operating the vehicle either illegally or without the owner’s permission. You can also be denied these benefits if you were convicted of a criminal offense that resulted in the accident.
If you were denied Statutory Accident Benefits from your insurer, it’s important that you speak to a lawyer who specializes in personal injury to make sure you weren’t unfairly denied.
How Do I Claim Accident Benefits?
After you’ve reported your car accident and any damages to your vehicle or property, it’s important that you report your injuries to your insurance company. Claiming restitution for damages to property and claiming accident benefits are two separate reports.
How Long Do I Have to Claim Accident Benefits?
You should report your injuries to your insurance provider within 7 days of the incident. Your insurer will then send you an Application for Benefits Form (also known as an OCF-1 Form), which you’ll have 30 days to complete and return. If you return the form later than the 30-day timeline, you’ll have to provide a reasonable explanation for why you couldn’t complete it within the timeframe.
Your insurance company will ask for details about your injuries in order to assess your need for a certain benefit. It’s important you have a legal representative with you to assist you in the process.
Next, you’ll need your doctor or another medical professional to fill out a Disability Certificate (OCF-3 Form). This form lists your injuries and disabilities that you sustained because of the accident and what tasks you can no longer do because of it, which may include going back to work.
Your insurer will than come back to you with a fixed amount to close your claim. Once you’ve accepted the amount, you cannot go back and request more. It’s very important that you make sure you’re happy with the amount offered and have consulted with a legal professional to make sure you’re not entitled to more.
How much you settle for with your insurance can affect your personal injury claim if you decide to go after the at-fault driver. If you’re considering taking legal action against the other driver, do not sign anything from your insurer without first talking to the lawyer that you want to have represent you.
What Do These Benefits Entail?
There are many different benefits that you may be eligible for.
Income Replacement Benefit
This is a weekly benefit that provides a partial income replacement if you cannot work. They are intended to replace 70% of your gross income, up to $400 per week. There is an option to increase your coverage up to $1000 per week.
If you don’t qualify for the Income Replacement Benefit, for instance if you are a student or stay-at-home parent and cannot continue your regular day-to-day activities, you may qualify for compensation of $185 a week.
This is a weekly benefit that reimburses you for expenses you’ve incurred if you can no longer continue to care for any member of your household under the age of 16. The age limit of 16 does not apply if the person suffers from a disability that requires you to care for them. Coverage is applicable to specific injuries but there is an option to add coverage to include all injuries.
Medical and Rehabilitation Benefits
This benefit pays for medical and rehabilitation expenses deemed necessary that aren’t covered by a government health plan or supplementary health plan.
Attendant Care Benefit
If it’s deemed you require a caregiver or attendant to help you recover, this benefit will pay for the expense.
For Medical, Rehabilitation and Attendant Care Benefits you will receive coverage up to $65,000 for non-catastrophic injuries. For catastrophic injuries you will receive up to $1 million. There is an option to increase non-catastrophic coverage to $130,000 and catastrophic coverage to $2 million.
Other Expenses Benefit
This benefit pays for additional expenses you may incur such as loss of education expenses if you cannot return to school or miss a prolonged period. It may also cover expenses of visitors, housekeeping expenses, home maintenance, and repairing or replacing items that may have been lost or damaged in the accident.
Death and Funeral Payments Benefit
If someone has died in a car accident, this is a lump sum payment available for the family to help pay the funeral expenses. This benefit provides $25,000 to your spouse, $10,000 to each of your dependants and a maximum of $6,000 for funeral expenses. You can increase this benefit to cover $50,000 for your spouse, $20,000 for your dependants and $8,000 for funeral expenses.
What If the Driver Doesn’t Have Insurance?
In the event that you were injured in a car accident and the drivers involved don’t have automobile insurance, you may be eligible for compensation from the Motor Vehicle Accident Claims Fund.
In Ontario, it is illegal to drive a motor vehicle without having insurance. Unfortunately, that doesn’t stop all non-insured drivers from getting behind the wheel. The Motor Vehicle Accident Claims fund was established to act as a last resort for people injured in an accident where insurance isn’t available.
You can learn more about the Motor Vehicle Accident Claims fund here.
Why Should I Hire a Personal Injury Lawyer?
If you’ve been injured in a car accident, it’s important you get full access to the accident benefits you are entitled to. The benefits you receive from insurance can also affect the amount you end up receiving in a civil litigation against the at-fault driver. Always speak to a lawyer that specializes in personal injury before making any decisions or signing any paperwork with insurance providers.
Why Choose De Rose Personal Injury Lawyers?
Our personal injury team at De Rose Lawyers will help you navigate the often overwhelming legal process. This way we can make sure you are fairly compensated. Our team of lawyers, with over 40 years of experience, will guide you through the complex legal, medical, and insurance issues, allowing you to focus on what’s important – your rehabilitation and recovery.