Area of Law: Personal Injury
Answer # 477
Automobile Accident benefits: What can you claim?Region: Ontario Answer # 477
Ontario’s “no fault” insurance means that your insurance company will always pay you the benefits covered under your insurance policy regardless of whether you or the other driver was responsible for causing the accident. However, these no fault accident benefits only apply to compensation for bodily injury, and not to compensation for property damage.
File an insurance claim
If you have been injured in an automobile accident, you must file a claim in order to receive accident benefits. There are two steps involved in filing a claim:
1. Notify your insurance company
Within seven days of the accident you must notify your insurance company, or if you do not have insurance, you must notify the insurance company of the other vehicle involved in the accident.
2. Complete the accident benefit claim application
The claim application will include:
- a form which is to be completed by your employer that verifies your loss of income, and
- a form to be completed by an authorized health professional, such as a medical doctor, chiropractor, occupational therapist, or physiotherapist that verifies the injuries which you sustained from the accident.
If you are self-employed then you will also be required to provide proof of income (such as an income tax return).
In some cases, your insurance company may also ask you to provide a sworn statement explaining the circumstances of the accident and the injuries you suffered.
What benefits can you claim?
All basic automobile insurance policies in Ontario include Statutory Accident Benefits that you can claim if you are injured in an automobile accident. In most cases, additional coverage can be purchased. The minimum benefits and amounts you can claim include:
1. Pain and suffering
If your injuries are permanent and serious, you can sue the other driver for compensation for your pain and suffering (also referred to as non-pecuniary general damages). The permanent and serious injuries can be either physical or psychological. Whether your injuries are permanent and serious is decided by a judge based on medical evidence. If a judge awards you compensation for such injuries, a $38,000 deductible will be subtracted from the amount awarded.
2. Loss of income and earning ability
Loss of income benefits
One automobile accident benefit you may claim is for compensation for both present and future loss of income and earning ability. There is no requirement that your injuries be serious or permanent. If the accident happened before September 1, 2010, you can claim 80% of your net income. For accidents which occurred after that date, you can claim compensation for loss of income up-to 70% of the gross income you lost, starting seven days after the accident, to a maximum of $400 a week.
If you were unemployed at the time of the accident, you may qualify for payment of a “non-earner” benefit of $185 per week for a maximum of two years, after a four-week waiting period. To qualify for this benefit, you must suffer a complete inability to carry on your normal activities as a result of and within 104 weeks of the accident, you do not qualify for Income Replacement Benefits, you no longer qualify for Caregiver Benefits, you were a full-time student, or you have completed your education in the past year but haven’t yet secured employment related to your education.
3. Health costs
(i) Medical and Rehabilitation benefits
Accident benefit claims for medical and rehabilitation costs due to a non-catastrophic injury (for example, sprains and broken bones) are limited to $50,000.
(ii) Attendant Care
You may also be eligible for attendant care benefits of up-to $36,000 over two years, if you require assistance with daily activities due to an accident resulting in non-catastrophic injuries.
If you claim both medical and rehabilitation benefits and attendant care benefits for non-catastrophic injuries, you can only receive a total combined maximum amount of $65,000.
(i) Medical and Rehabilitation benefits
If you suffer a “catastrophic” injury as a result of the accident, for example, if an accident renders you a paraplegic or you lose a limb, or suffer complete loss of vision, medical and rehabilitation costs covered by an accident benefit claim are currently limited to $1,000,000.
(ii) Attendant Care
You may also be eligible for attendant care benefits if you require assistance with daily activities due to an accident resulting in catastrophic injuries. Costs for related attendant care expenses in the case of catastrophic injuries are also limited to $1,000,000.
If you claim both Medical and Rehabilitation benefits and Attendant Care benefits for catastrophic injuries, you can only receive a total combined maximum amount of, $1,000,000.
4. Housekeeping and home maintenance
If, because of the accident, you are unable to maintain your home as you did before the accident, you can make a claim for reimbursement of the expenses you have to pay for housekeeping and home maintenance work, up-to a maximum of $100 per week. This coverage can only be claimed by those who suffer a catastrophic injury.
5. Claims of family members
Under Ontario’s Family Law Act, family members may also be able to sue for loss of guidance, care and companionship if the accident caused permanent and serious injury, whether physical or psychological, or resulted in a family member’s death. The FLA claims are subject to a $15,000 deductible except in cases where the claim exceeds $50,000, or where death occurred as a result of the accident.
Family members that are eligible to make a claim include the injured person’s spouse, children, grandchildren, parents, grandparents and siblings. The common types of damages that can be claimed under the FLA are:
- expenses that were paid for the benefit of the injured person
- loss of income of the person injured
- travel expenses to visit or care for the injured person
- funeral expenses
- compensation for providing caregiver services, housekeeping services or other services for the injured person
- compensation for loss of guidance, care and companionship that the family member might reasonably have expected to receive if the injury or death had not occurred
6. Caregiver benefits
If you were a caregiver at the time of the accident, and you are unable to carry on your caregiving duties, you may be entitled to receive the reasonable costs of paying for professional care to a maximum of $250 per week, plus $50 for each additional child. This coverage can only be claimed by those who suffer a catastrophic injury.
7. Death benefits and funeral costs
Death benefits of $25,000 are payable to the deceased’s spouse and an additional $10,000 to each of the deceased’s dependants.
Funeral expenses are paid to a maximum of $6,000.
If you plan to sue as a result of an automobile accident, you are usually required by law to notify the person being sued within 120 days of the accident, and you must normally begin the lawsuit within two years of the accident.
If you or someone you care about has been injured in an automobile accident, contact our preferred Personal Injury lawyers and see who’s right for you. They offer a free consultation and do not charge up-front fees:
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