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ACCIDENT BENEFIT DISPUTE LAWYER

Ontario Accident Benefit Dispute Lawyers

ACCIDENT BENEFIT DISPUTE LAWYER

WHAT ARE ACCIDENT BENEFITS?

Any person injured in a vehicle accident in Ontario has the right to certain mandatory benefits from an insurance company. These rights are outlined in the Ontario Statutory Benefits Schedule.

If you are not at fault in the accident you will have two avenues to pursue compensation - Tort and Accident Benefits. However, if you are at fault you will be limited to recovery under Accident Benefits.

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Tort Claims

Tort Claims

Also known as third-party claims, your tort claim may provide compensation for economic losses that arise from your injury. This includes past and future loss of income, future health care expenses, pain and suffering, loss of enjoyment of life/companionship, and any other out-of-pocket expenses that have not been compensated for under Accident Benefits.
Medical Rehabilitation Benefits

Medical Rehabilitation Benefits

These are benefits available to an insured for reasonable and necessary expenses incurred with respect to injuries resulting from a motor vehicle accident. Medical rehabilitation benefits may include physiotherapy, chiropractic care, massage, psychological services, medication, and more.
Attendant Care

Attendant Care

If you are unable to care for yourself as a result of your accident, you may be eligible for assistance. In order to receive this benefit, you must be assessed by a medical professional. Care must be provided by an individual in the course of his/her employment, and there must be an incurred expense.
ACCIDENT BENEFIT DISPUTE LAWYER

How to Claim Accident Benefits

Step-by-Step Process
  • File a claim immediately after the accident. Once your insurance company has been notified, a complete Accident Benefits package will be mailed to you for your completion.

    Complete the Accident Benefits form application.

  • A form indicating income loss must be completed by your employer
  • A form regarding your injuries must be completed by an authorized healthcare professional (i.e, doctor, therapist)
  • Certain accident benefits may require you to complete a sworn statement to a representative of the insurance company
  • Eligibility depends on:
  • Your insurance policy
  • Circumstances surrounding the accident
  • The extent of injuries sustained

SUMMARY OF ACCIDENT BENEFITS

Depending on your injuries, you may qualify for some of the benefits in the following table:
Type of Benefit FOR ACCIDENTS ON OR AFTER SEPTEMBER 1, 2010 FOR ACCIDENTS ON OR AFTER JUNE 1, 2016
MEDICAL AND REHABILITATION BENEFITS
  • Non-catastrophic – Maximum of $50,000 or 10 years if over age 15 at date of loss, otherwise to age 25
  • Catastrophic – Maximum of $1,000,00
  • Non-catastrophic – Maximum of $65,000 (including attendant care benefits) or 260 weeks (5 years) if over age 18 at date of loss, otherwise to age 28
  • Catastrophic – Maximum of $1,000,000 (including attendant care benefits)
CASE MANAGEMENT SERVICES
  • Non-catastrophic – Not available
  • Catastrophic – Available (part of $1,000,000 medical and rehabitation limit)
  • Non-catastrophic – Not available
  • Catastrophic – Available (part of $1,000,000, medical, rehabilitation and attendant care limit)
ATTENDANT CARE BENEFITS
  • Non-catastrophic – Maximum of $3,000 per month and $36,000 for up to 2 years after accident
  • Catastrophic – Maximum of $6,000 per month and $1,000,000
  • Non-catastrophic – Maximum of $3,000 per month and $65,000 (including medical and rehabilitation benefits) for up to 260 weeks (5 years) if over age 18 at date of loss, otherwise to age 28
  • Catastrophic – Maximum of $6,000 per month and $1,000,000 (including medical and rehabilitation benefits)
TRANSPORTATION COSTS
  • Non-catastrophic – Only for the portion of any distance over 50 km
  • Catastrophic – Available
HOUSEKEEPING AND HOME MAINTENANCE EXPENSES
  • Non-catastrophic – Not available
  • Catastrophic – Lifetime maximum of $100 per week
INCOME REPLACEMENT BENEFIT REPORTS
  • Insurer shall pay up to $2,500 for an Income Replacement Benefit report. Applies to both employed and self-employed situations. Includes review of insurer prepared or commissioned reports. Expense must be reasonable. Prior approval not required.
INCOME REPLACEMENT BENEFITS
  • Payable after 26 weeks at $185 per week if completely unable to carry on a normal life. Increases to $320 per week from 104 weeks after accident if a student within the 52 weeks prior to the accident. Benefits reduced by formula at age 65 (subject to 2 year minimum). Payable after age 16 and for life.    
  • Payable after 4 weeks at $185 per week if completely unable to carry on a normal life. Payable after age 18 and for maximum of 104 weeks.
CAREGIVER BENEFITS
  • Non-Catastrophic – Not Available
  • Catastrophic – Payable, without waiting period, if substantially unable to continue caregiving activities, at maximum of $250 per week for first person, plus $50 for each additional person in need of care. Changes at 104 weeks to a more stringent “complete inability” test. Terminates once children attain age 16 or no longer a person in need of care. No adjustment at age 65.
ACCIDENT BENEFIT DISPUTE LAWYER

Why Would Accident Benefits be Disputed?

  • Insufficient or lack of evidence (e.g., medical records, proof of loss wages)
  • Incomplete or inaccurate forms
  • Missing filing deadline (typically within 30 days of the accident occurring)
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ACCIDENT BENEFIT DISPUTE LAWYER

How a Personal Injury Lawyer can Help you with Accident Benefit Disputes

Strype Personal Injury Lawyers will negotiate  with your insurance company and refer you to our extensive network of medical professionals to ensure that you  receive the best treatment and compensation for the injuries sustained as a result of an accident. We can also help with timely access to medical services in an effort to prevent further injury or degeneration of your condition.

We will be your advocate and will negotiate or litigate for as long as it takes for you to receive a reasonable settlement. We’ll work closely with you to ensure you receive all available benefits (accident, disability, third-party liability, or tort).

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