A motor vehicle accident can be traumatic, as well as both financially and physically devastating. Not only are you forced to endure the injuries suffered in the accident, but you can also potentially face the added anxiety of being unable to work, unable to pay your bills, and worry about how you will pay for the medical treatments not covered by OHIP.
This is where Statutory Accident Benefits come into play. They pay for expenses related to injuries from motor vehicle accidents. These include health costs not covered by OHIP, a certain level of income replacement, as well as other benefits.
This is a form of no-fault insurance, that is mandatory and included in every auto insurance policy in Ontario. These provide certain benefits to an individual who is injured in a car accident, regardless of who is actually at fault.
Under a no-fault insurance system, any benefits claim must be submitted to your own insurance company rather than the insurance of the at fault driver. In fact, the negligent driver will likewise apply to their own insurance for their claims. It should be noted that if you do not have insurance (i.e. you don’t have a car and were merely a passenger, or you were a pedestrian struck by a car), then your claim would go through the insurance provider of the at-fault driver. Should you be in a situation where no party has insurance, the government of Ontario has set up the Motor Vehicle Accident Claims Fund (MVACF). This is a government insurance program which provides compensation when neither party to the accident has insurance (and the recipient of the fund must not be the at-fault driver).
To help You better Understand What is Covered by Statutory Accident Benefits, Here Are Six Things You Ought to Know.
As a victim of a motor vehicle accident, you are entitled to receive medical and rehabilitation benefits. The Statutory Accident Benefits Schedule established three categories.
The first one is the Minor Injury Guideline (MIG) that was established on September 1, 2010, as a part of the new legislature. Under the Minor Injury Guideline, a victim of a motor vehicle accident can only claim a maximum of $3,500.00 for rehabilitative treatment, out of which $2,200.00 is of pre-approved treatment. A minor injury is defined as “a sprain, strain, whiplash associated disorder, contusion abrasion, laceration or subluxation, and any clinically associated sequelae.” However, the victim of a motor vehicle accident may be removed from the MIG category if he or she suffered an injury before the accident, which was documented by a medical practitioner, and the prior injury was exacerbated by the motor vehicle accident. Moreover, if you have developed psychological impairment and/or chronic pain syndrome as a direct result of the injuries sustained in the motor vehicle accident, you may be removed from the MIG category.
The second one is Non-Minor Injury, which is any other injury than “a sprain, strain, whiplash associated disorder, contusion abrasion, laceration or subluxation, and any clinically associated sequelae” and does not rise to the level of a catastrophic injury. Under this category a victim of a motor vehicle accident can claim a maximum of $65,000.00, unless optional benefits were purchased, for rehabilitative treatment expenses, should they be “reasonable and necessary”. Further, if you can show reasonable cause for assistance, you might be entitled to Attendant Care Benefits that can be used to pay for “reasonable and necessary” expenses incurred when hiring someone to help you with such activities as dressing, preparing meals, bathing, grooming, etc. You might qualify for up to $3,000,00 per month for a maximum of five years.
The third and final category is Catastrophic Impairment, which combines medical, rehab, and care limits of $1,000.000.00. This category also provides elevated Attendant Care limits of $6,000.00 per month, as well as, housekeeping expenses up to $100.00 per week for reasonable and necessary expenses incurred by or on your behalf. The Catastrophic Impairment category is reserved to the victims that suffered dramatic injuries, such as a traumatic brain injury, total loss of vision in both eyes, an amputation of a single arm or leg where a specific criteria is met, such as it must be through tibia or higher, severe psychological impairments, and/or where there is 55% of a whole person impairment based on the American Medical Association Guides 4th and 6th edition and more.
Choosing the appropriate benefits might be a complex and confusing task. At P&M Injury Law our professionals will be happy to discuss all options available to you during a free consultation. Call today to book an appointment at 416-223-7000.
As a victim of a motor vehicle accident, you may be entitled to receive no-fault benefits from your insurance provider in a form of bi-weekly financial compensation. If you are unable to return to your employment duties as a direct result of the injuries sustained in the motor vehicle accident you may be entitled to income replacement benefits, which are payable to a person who was either employed or self-employed for at least 26 out of 52 weeks before the accident and suffered a substantial inability to perform the essential tasks of his/her employment or self-employment. Unless you have purchased optional coverage, the amount you may receive in income replacement benefits is 70% of your gross income, prior to the motor vehicle accident, up to a maximum of $400.00 per week. However, after two years since the date of the accident the threshold for receiving IRBs becomes substantially more difficult. The Statutory Accident Benefits Schedule provides a post-two-year test as follows: “as a result of the accident, the insured person is suffering a complete inability to engage in any employment for which he or she is reasonably suited by education, training, or experience.”
In order to qualify for income replacement benefits, you must also submit a Disability Certificate (OCF-3) completed by a regulated professional, as well, as an Employment Confirmation Form (OCF-2). In certain instances you might qualify for more than just one financial benefit, then you will have to elect the one you wish to claim by submitting an Election of Benefit Form (OCF-10), however, be aware that once you have elected the benefits you wish to claim you may not go back and change it to another one. You may be required to attend insurer examinations where doctors will examine your ability to return to work. Failing to attend insurer examinations may result in the suspension of the benefit. You also cannot continue working, either part-time or full time, doing so might affect the amount of the income replacement benefits that you are entitled or even result in your insurance provider requesting you to repay the income replacement benefits paid to you. The income replacement benefits are also not payable for the first week of disability.
Choosing the appropriate benefits might be a complex and confusing task. At P&M Injury Law our professionals will be happy to discuss all options available to you during a free consultation. Call today to book an appointment at 416-223-7000.
As a victim of a motor vehicle accident, you may be eligible to receive Non-Earner Benefits, which provide a bi-weekly financial compensation in the amount of $185.00 per week for the period up to two years, to motor vehicle accident victims, in most cases, who do not qualify for income replacement benefits.
Pursuant to the Statutory Accident Benefits Schedule, Non-Earner Benefits are payable to those persons who suffer a complete inability to carry on a normal life. The complete inability is defined as follows: “a person suffers a complete inability to carry on a normal life as a result of an accident if, as a result of the accident, the person sustains an impairment that continuously prevents the person from engaging in substantially all of the activities in which the person ordinarily engaged before the accident.”
In order to qualify for Non-Earner Benefits, similarly to Income Replacement Benefits, you must submit a Disability Certificate (OCF-3) completed by a regulated professional, as well as, an Activities of Normal Life Form (OCF-12). In certain instances you might qualify for more than just one financial benefit, then you will have to elect the one you wish to claim by submitting an Election of Benefit Form (OCF-10), however, be aware that once you have elected the benefits you wish to claim you may not go back and change it to another one. You may be required to attend insurer examinations where doctors will examine your ability to return to work. Failing to attend insurer examinations may result in the suspension of the benefits. The Non-Earner Benefits are also not payable for the four-week of disability.
Choosing the appropriate benefits might be a complex and confusing task. At P&M Injury Law our professionals will be happy to discuss all options available to you during a free consultation. Call today to book an appointment at 416-223-7000.
