Accident Benefits – What can I recover if I’m in a car accident?

July 2013

Car accidents can happen to anyone. Whether it is someone’s fault, or simply weather related, it can be overwhelming for people involved. It is important to know where to turn to and what expenses and treatment are covered. In Ontario, there are two aspects to law suits if you have been involved in a car accident. The first is the Accident Benefits – or what used to be called the no fault benefits. These basic benefits are available to anyone with car insurance or who is injured by someone with car insurance, regardless who is at fault. The second is the Tort side – this is the law suit against the person who is to blame (or is negligent) for the accident. Both parts of the lawsuit are important to make sure you are fairly compensated and are not out of pocket for expenses that arise from someone else’s mistake.

This article will focus on the benefits available for Accident Benefits. It is important to understand that while an individual may have a large amount of benefits available to them in a particular category, Accident Benefits are not meant to be a windfall for claimants. If you do not use the full amount of benefits available to you in a category, you do not get a payment for the remainder. It is therefore important that you receive all of the recommended treatment from your service providers and focus on getting better, especially following a car accident.

Accident Benefits

Accident Benefits are designed to ensure that everyone in Ontario that is involved in a car accident gets a basic level of income replacement if they can no longer work and to ensure their medical expenses are covered to a certain level so that everyone can get the treatment they need. How much money is available for things such as Medical and Rehabilitation Expenses depends primarily on your injuries that you have sustained.

Injury Categories

In Ontario, Accident Benefits place injuries into three categories; Minor Injury Guideline (MIG), Non Catastrophic and Catastrophic. The MIG is designed for individuals who suffer from soft tissue injuries that will typically heal quickly and with a minimal amount of treatment. Being placed in the MIG will only allow an individual to receive $3,500 in Medical/Rehabilitation benefits and will disqualify other benefits such as Attendant Care. This amount is usually not enough for individuals to properly heal and it is important to speak to a lawyer about trying to get out of this category.

Non Catastrophic injuries essentially cover everything beyond soft tissue injuries that fall short of the Catastrophic level. Your Medical/Rehabilitation limits are $50,000, you can access $36,000 in Attendant Care and there is an expectation that you will need a longer time to heal. Note however that these amounts are proposed to be reduced in the future under proposed legislation by the Provincial Government

Catastrophic injuries are the most severe injuries an individual can suffer such as being rendered a paraplegic or quadriplegic, amputation of a limb, blindness in both eyes or a severe brain injury. The limits for these injuries is $1 million for Medical/Rehabilitation benefits and $1 million for Attendant Care, but again note that these amounts are proposed to change in the future under proposed legislation.

Benefit Categories

Medical/Rehabilitation: This benefit is designed to get you the medical treatment you need to heal. They include treatments such as Physiotherapy, Massage Therapy and Chiropractic, but also include items such as Medications, Assistive Devices such as canes or tub transfers. In severe cases, this category can include things such as Vehicle or Home Modifications to help an injured person adapt to their injuries and their new limitations. Psychological counseling and behavioral therapy such as programs designed for driver anxiety are also funded through these amounts.

Attendant Care: This benefit is designed to pay for a Personal Support Worker (PSW) to assist you with personal care activities such as bathing, toileting, dressing or feeding yourself. An Occupational Therapist will typically complete an assessment and determine what personal care activities you are no longer able to complete.

Income Replacement Benefit: This benefit is designed to assist people who cannot work because of their injuries caused by the car accident. This benefit will cover 70% of your pre-accident gross income up to $400 per week (tax free). There is the ability to purchase optional benefits to increase the maximum from $400 per week and you should speak to a broker about this option for anyone who earns more than $30,000 per year to determine if you should purchase optional benefits and increase your maximum.

Non-Earner Benefits: This benefit is designed for individuals who suffer a complete inability to carry on their normal activities due to their injuries from a car accident. This benefit totals $185 per week (tax free) and is designed for people who were not working before the accident. Note that if you were not working because you were a student, this weekly amount increases to $320 per week (tax free) two years after the accident.

Caregiver Benefits: This benefit is for people who were the primary caregiver to a dependent at the time of the accident. It is meant to reimburse you for expenses you will incur as a result of not being able to take care of your children or dependents after the accident. You must incur the expense, which means you must pay for someone to be taking care of them while you recover.

Other Expenses: There are other expenses that arise as a result of an accident, such as lost educational expenses since you cannot complete a semester from school, the cost of family members visiting during your treatment and recovery or housekeeping and home maintenance to assist you with tasks you cannot complete while you recover. Other items such as replacing clothing that was lost or damaged in the car accident can also be covered. It is important to note that with regards to housekeeping and home maintenance, unless you are catastrophically injured, you must purchase optional benefits in order to receive the $100 per week for a cleaning service or individual to come and assist you. Again you should speak with your insurance broker about whether you want to purchase this optional benefit.

Death and Funeral Payments: There is a lump-sum payment available for survivors of a person killed in a car accident to help pay for a funeral. This benefit is limited for a spouse at $25,000, or $50,000 if the optional death and funeral benefit is purchased. If the deceased person had no spouse, the dependents of the deceased person will be entitled to share $25,000 equally. Furthermore, if you were dependent on the person who died, or if the person who died was obliged under a court order to provide support to you, you are then entitled to a benefit of $10,000, or $20,000 if the additional optional death and funeral benefit was purchased.

It is important if you have been involved in a car accident to consult a lawyer to make sure you know what benefits you qualify for and to advocate on your behalf. Cohen Highley lawyers has a team of skilled and experienced lawyers that can assist you. For a free consultation, contact Matt Reid at 519-672-9330 or by e-mail.

Author

Matt practises in the area of civil litigation with an emphasis on personal injury litigation. Matt attended Western University where he obtained his Bachelor of Arts (Hons.) in 2009 and received his Juris Doctor from the University of Ottawa in 2012. Matt was called to the Bar of Ontario in 2013. More →