Accident Benefits & Tort
If you are not at fault in the accident you will have two avenues to pursue compensation. They are called Tort and Accident Benefits.
However, if you are at fault you will be limited to recovery under Accident Benefits.
Tort
Also known as third party claims, your tort claim may provide compensation for all of your 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.
What Are Accident Benefits?
Any person injured in an Ontario motor vehicle accident has the right to certain mandatory benefits from an insurance company. These rights are found under the Statutory Accident Benefits Schedule.
http://www.ontario.ca/laws/regulation/100034
Accident Benefits should be applied for promptly. Once your insurance company has been notified, a complete Accident Benefits package will be mailed to you for your completion.
Who Pays Accident Benefits?
If you have automobile insurance, your insurance company will pay accident benefits. If not, you will be entitled as per the Liability Rule, R268(2) of the Insurance Act.
What are the Benefits I am Entitled to?
Depending on your injuries, you may qualify for some of the benefits listed below.
| 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 $1,000,000 |
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 |
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| Housekeeping and Home Maintenance Expenses* | Non-catastrophic – Not available
Catastrophic – Lifetime maximum of $100 per week |
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| Death Benefits* | $25,000 to spouse, plus $10,000 per dependent including supported former spouse | |
| Funeral Benefits* | Up to a $6,000 maximum | |
| Income Replacement Benefit Reports* | Insurer shall pay up to $2,500 fo 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. Prioer approval not required. | |
| Income Replacement Benfits* | After first week, paid at 70% of gross pre-Accident income (reduced by collateral benefits available or received) to maximum $400 per week (reduced by 70% of post-Accident earned income). Continued payment after 104 weeks is subject to a more stringent “any occuptation” test and payable at a minimum of $185 per week. Benefits reduce by formula at age 65 (subject to a 2 year minimum). | |
| Non-earner 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. |
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*Optional enhanced benefits available.
What are 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. These may include benefits such as physiotherapy, chiropractic care, massage, psychological services, medication, etc.
What is Attendant Care
If you are unable to care for yourself, you may be eligible for assistance. In order to receive this benefit, you must be assessed accordingly. Care must be provided by an individual in the course of his/her employment and there must be an incurred expense.