Motor Vehicle Accidents, No-Fault Accident Benefits

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THE DISCLAIMER
The information on this website is not, nor is it intended to be, legal advice.  You should seek legal advice on your individual situation.

Motor Vehicle Accidents

What are my rights if I am injured in a car or motor vehicle accident?

Anyone injured in a motor vehicle accident, also known as an automobile, snowmobile, ATV, motorcycle or dirtbike accident is automatically entitled to "No-Fault Accident Benefits". No-Fault Accident Benefits are available whether you were driving, or were a passenger or a pedestrian hit by a motor vehicle (and are available even if the accident was your fault). Making an Accident Benefits claim should not affect your insurance rates.

No-Fault Accident Benefits



Every automobile insurance policy in Ontario contains mandatory accident benefits coverage.  The following is a list of Statutory Accident Benefits that are potentially avaliable to you:

-Income Replacement Benefits.
-Non Earner Benefits.
-Caregiver Benefits.
-Medical & Rehabilitation Benefits.
-Attendant Care Benefits.
-Housekeeping & Home Maintenance.
-Lost Educational Expenses.
-Death Benefits.
-Funeral Expenses.
-Travel Expences.

Who is my Accident Benefit Insurer?

If you are injured in a car accident, no matter who is at fault, you are entitled to no-fault accident benefits. These benefits are available to you from either:

-Your own car insurance company;
-The car insurance company of any other vehicle involved in the accident;
-The insurance company of a person you are dependant upon; or
-The Motor Vehicle Accident Claims Fund(1-800-268-7188).

Claiming Benefits



What steps must I take when claiming benefits?

You must notify your insurance company within 7 days from the date of the accident that you wish to apply for benefits and your insurance company must then provide you with the application forms.  You must file the completed application forms with your insurance company within 30 days of recieving them.  If you cannot do so within 30 days because of the severety of your inquiries, the application must be made as soon as reasonably possible.  You must also consent to the disclosure of medical information and or loss of income information to your insurance company to obtain this information directly from your doctor and or employer.

If you are having difficulties recovering the benefits you are entitled to, a lawyer should be consulted.  If you have been denied a benefit, you must file an Application for Mediation within 2 years from the date of the denial of the benefit.  Any lawsuit, to enforce the payment of these benefits, must be commenced within two years from the time the insurance company refused to pay the benefit(and only after a mediation has taken place) r within 90 days after the mediator reports to the parties.

Do I need a paralegal for either my lawsuit or my no-fault accident benefits?

Yes a paralegal can help assess what types of no-fault accident benefits are available to you.  A paralegal can also assist in ensuring that you recieve the proper no-fault benefits.

Do I have to be an occupant in an automobile or motor vehicle to be eligable for no-fault accident benefits?

No. Pedestrians and cyclists who were injured in an accident involving a vehicle may also be entitled to no-fault accident benefits.

Who else is covered by No-Fault Accident Benefits?

In addition to the classes of people listed above i.e. passengers, pedestrians and cyclists, any member of your immediate family who was not involved in the accident may also be entitled to recover benefits if he or she suffers psychological or mental injury as a result of your accident.

If I miss the deadline of 30 days, can I still apply for benefits?

Most insurance companies will accept late applications if you have a reasonable explanation for the delay.  However, it iss always best to meet the 30 day time limit.  No benefit is payable until a complete application is sent and approved by the insurance company.

I have some other insurance coverage, such as health and drug benefits, short term benefits asnd long term disability benefits, through my employer.  Does the no-fault accident benefits coverage still apply?

Yes, however, you must go to those other benefit planns first and seek coverage.  If these plans fail to cover all or part of your losses, then the no-fault  accident benefits may be required to pay additional amounts.

Supplementary Medical Benefits and Rehabilitation Benefits



What kinds of expenses or services is my insurance company required to pay for?

The Insurance company may be required to pay all of the reasonable expenses incurred as a result of your accident including:
-medical, hospital and nursing care, not covered by OHIP
-chiropractic, psycological and occupational therapy etc.
-medication, prescription eyewear, dental devices and medical aids
-transportation over and above 50km to and from treatment sessions
-social and vocational rehabilitation
-home renovations and vehicle modifications

Are there limits on what I can recieve for medical expenses?

As of September 1,2010, new limits on medical and rehabilitation expenses apply.
Minor injuries will be eligable for $3500 in medical and rehabilitation services.  More serious injuries (but not catastrophic injuries) will be eligable for up to $50,000 in medical and rehabilitation expenses for up to ten years after the collision.  Optional coverage is available and may apply if you purchased it to increase the amounts to  $100,000 or $1,100,000.  However, optional coverage does not increase the maximum amount for minor injuries.
If your injury is considered catastrophic, then you may recieve up to 1,000,000 in medical and rehabilitation benefits over your lifetime. Optional coverage may increase this amount by an additional $1,000,000

What do I need to do in order to get treatment? What does my insurance company require?

You must submit a Treatment Plan to the insurance company.  This must be done before any treatment commences.  The treatment plan must be prepared by a health professional or a social worker and signed by one of the following health practitioners:

-physician, including your famuly doctor
-psychologist
-physiotherapist
-dentist
-optomotrist
-chiropractor
-registered nurse
-speech language pathologist

Insurance companies are entitled to refuse to pay for treatment unless a treatment plan is completed and approved.

Can I arrange for my own medical or rehabilitation assesment to determine what treatment I need?

Yes. Your own treating health care specialists can perform an assessment under the regulation and, in most cases, the insurance company is obligated to pay for the cost of that assesment.

Attendant Care Benefits



Is my insurance company required to pay for an aide or attendant to help me at home?

If you have been injured in an accident, your insurance company may be required to pay the cost of providing fir an aide or attendant.  As of September 2010,  These benefits can include the services of one of your family members caring for you at home only if they are ordinarily employed as an attendant providing those services. The insurance regulations have special forms which must be completed by an occupational thereapist or physician in order to qualify for this benefit.

How much can I recieve for attendant care?

You can recieve up to $3,000 per month for attendant care for two years, up to a maximum of $36,000.  If you have purchased optional coverage, you can recieve up to $72,000 or $1,072,000.
If your injury is catastrophic, you can recieve up to $1,000,000 for attendant care.

Lost Education Expenses



When am I entitled to receive payment for lost education expenses?

If you are unable to continue in a program that you were enrolled in at the time of the accident, the insurance company will pay for lost educational expenses.

What is the maximum amount I can receive for lost education expenses?

The maximum amount you can receive is $15,000.  This amount is meant to compensate for expenses incurred before the accidentm such as tuition, books, equiptment, and room and board.

Catastrophic Impairment



What is "catastrophic" impairment?

Various injuries may be considered catastrophic by medical experts who conduct these assessments.  Some examples of catastrophic impairments are paraplegia, quadraplegia, permanent loss of a limb, loss of vision in both eyes, and certain brain injuries.  Where you do not meet one of these tests, once your condition has stabalized or two years has elapsed since the accident, you may make an application to your insurance company for a determination that the impairment is catastrophic.

What benefits am I entitled to if my injury is considered to be "catastrophic"?

If your injury is defined as catastrophic impairment by the Insurance Act, you are entitled to a much higher level of medical and rehabilitation benefits and attendant care benefits (a maximum of $1,000,000 for medical and rehabilitaion benefits and $1,000,000 for attendant care benefits).  You are also entitled to $100 per week for housekeeping and home maintenance assistance.

These benefits are payable over your entire lifetime.

You may also be entitled to a non-earner or caregiver benefit.

Optional Benefits

What if I have optional benefits?

Ensure that you contact your insurace company or a lawyer to determine what optional benefits you have purchased.

Settlement Regulation

Can a no-fault accident benefits claim be settled on a lump sum basis?

Yes. However, in most cases these cannont be settled within one year of the accident.

Weekly Income Replacement Benefits


(Specified Benefit)

When am I entitled to recieve weekly income replacement benefits?

You are entitled to recieve weekly income replacement benefits (excluding the first week) after a collision in the following circumstances:

-you were employed on the date of the accident and thereafter suffered a substantial inability to perform the essential tasks of your employment.
-you were not employed at the time of the accident but worked at least 26 of the 52 weeks before the accident (or were recieving EI benefits at the time of the accident) and thereafter, suffered a substantial inability to perform the essential tasks of the employment in which you spent most of your time durning the 52 weeks before the accident.

When can I begin receiving income replacement benefits?

You will not receive income replacement benefits for the first 7 days after a collision. Then, as long as you qualify, you can receive 70% of your gross weekly income less any benefits you may be entitled to from other insurance policies or employment plans.

What is the maximum amount of income replacement benefits I can receive?

You can receive a maximum of $400 per week. If optional coverage was purchased, you can receive $600, $800 or $1,000 per week. If you are entitled to Group Benefits or private benefits you will still be entitled to up to $400 in addition to the Group Benefits.

As a self employed person, can I receive income replacement benefits?

Yes. Self-employed persons are entitled depending on their income and expense situation. Usually an accountant will have to calculate your entitlement.

For how long can I receive these benefits?

If you qualify, these benefits are available to you up to age 65 and then start to reduce on a gradual basis to age 69.

How will attempting to return to work affect my weekly benefits?

You may attempt to return to work at any time during the first 104 weeks after the accident without affecting your entitlement to start receiving income replacement benefits if you cannot continue with the employment because of the accident

Non Earner Benefits


(Specified Benefit)

When am I entitled to receive "non earner benefits"?

If, at the time of the accident, you were not working but were enrolled in school or had completed your education during the year prior to the accident and were not employed in a job that reflected your education, you may be entitled to this benefit if you suffer a complete inability to carry on a normal life and are over 16 years of age.

What is the maximum amount of non earner benfit I can receive?

The amount of the non earner benefit is $185 per week.  However, nothing is payable for the first 26 weeks after the accident.  If you were enrolled in school or had completer your education in the year prior to the accident, you are entitled to a non earner benefit in the amount of $320 per week after the first 104-week period has expired.

Caregiver Benefits


(Specified Benefit)

When am I entitled to receive "caregiver benefits"?

You may be entitled to a caregiver benefit if your injury is considered to be catastrophic and you were living with and were the primary caregiver for a person in need of care and were not being paid for these activities.

What is the maximum amount of care giver benefits I can receive?

The maximum amount of the caregiver benefit is $250 per week fir the first person in need of care plus $50 per week for each additional person - catastrophic injuries only.  If you purchasedoptional coverage, you can receive the careguver benefit ($250 per week for the first dependant plus $50 for each additional dependant) regardless of the injury you have sustained.

Electing for Specified Benefits



Can I receive income replacement benefits, non-earner benefits and caregiver benefits all at the same time?

No. Only one of the income replacement, non-earner and caregiver benefits is payable for any given period of time.  Advice from a knowledgeable lawyer may be needed to make the correct decision.

Housekeeping and Home Maintenance

What is the maximum amount I can receive for housekeeping and home maintenance expenses?

You can receive $100 per week for all reasonable expenses for housekeeping and home maintenance, if your injury is considered to be catastrophic.  If you purchased optional coverage, you can recieve $100 per week for all reasonable expenses for housekeeping and home maintenance, regardless of the injury you have sustained.

How long can I receive payment for these expenses?

Your housekeeping and home maintenance expenses are paid for up to 104 weeks unless the injury is catastrophic.

Other Expenses

What other expenses can I receive payment for from my insurance company?

Your insurance company may be obligated to replace or repair clothing damaged in the accident, prescription eyewear, dentures, hearing aids, prostheses, and other medical or dental devices lost or damaged in the accident.

Funeral and Death Benefits

If a family member dies in an accident, what expenses is the insurance company required to pay for?

When an isured person dies as a result of a motor vehicle accident, the insurance company may be required to pay funeral expenses incurred up to a maximum of $6000.

Are there other payments that the family may be entitled to receive if someone dies in an accident?

Each person that was a dependant of the deceased is entitled to received $10,000. If the deceased was married, a sum of $25,000 would be payable to his or her spouse. If the deceased was not married but was survived by a dependant(s), the $25,000 is then divided equally among the dependants.  If the deceased was a dependant at the time of the accident, $10,000 would be payable to the person upon whom the deceased was dependant.

What do optional death and funeral benefit include?

If you have purchased optional death and funeral benefits, the benefit for loss od a spouse is $50,000, the loss of a dependant, $20,000 and a maximum amount of $8,000 for funeral expenses.

Expense of Visitors

Who is entitled to receive payment for "visiting expenses" incurred while I am injured?

If your family members and other individuals who were living with you at the time of your accident visit you, they are entitled to payment of all reasonable and necessary expenses incurred as a result of the accident during your treatment or recovery,  There is no payment after 104 weeks unless the injury is catastrophic.

Stoppage or Refusal to pay Benefits

When can the insurance company stop payment of the specified benefits such as income replacement, caregiver and non-earner benefits?

Your insurance company may stop payment of weekly benefits in the following cases:
-you failed or refused to submit a completed disability certificate
-you failed or refused to submit a completed disability certificate
-you failed to attend the insurance company examination or provide reasonable information for the assessment
-the insurance company's report states you no longer meet the applicable test

When is your insurance company not obligated to pay benefits?

Your insurance company is not obligated to pay income replacement benefits, non-earner benefits, lost education expenses, expenses of visitors or home maintenance expenses if you were the driver of an automobile at the time of the accident and:
-Knew or ought to have known that the automobile was not insured; or
-were not licensed to drive
-were an excluded driver under the contract of insurance for the vehicle which you were driving at the time of the accident
-were driving a vehicle or were an occupant of a vehicle when you ought to have known that the vehicle was being driven without the owners consent
-were convicted of impaired driving
-were convicted of driving with a blood alcohol level exceeding legal limits
-were convicted of failing to provide a breath sample
-were engaged in, or were an occupant of an automobile that was being used in connection with a criminal offence
-misstated fact to the insurance company in order to obtain motor vehicle insurance
-any person who is convicted of a criminal offence or is an occupant of a vehicle being used for the commission of a criminal offence.

Medical Examinations

Can the insurance company require me to go to their doctor or other or other health care worker for a physical or psycological examination?

Yes.  To assist an insurance company to determine if an insured person is entitled to a benefit, the insurance company may, as often as is "reasonably necessary," require the insurance company may not require an injured person to attend an insurance examination with respect to an application for a benefit that is provided under the Minor Injury Guidelines.

Do I have to attend an examination before an application for no-fault accident benefits is submitted?

No, unless you request or consent to the examination in order to obtain certain benefits before you submit your application for accident benefits.

Summary of No-Fault Accident Benefits

The following is a summary of some of the steps that must be taken to claim Accident Benefits:
-Determine which insurance company should pay the benefits.
-You must provide"written notice" to the accident benefits insurer within 7 days of the accident.
-complete an application for accident benefits within 30 days of receiving the forms from your insurance company.
-Your treating health care professionals and your employer must complete certain forms.
-if requested, you must, within 10 business days of the request, provide your insurance company with information they need to determine your entitlement to accident benefits, such as hospital records and family doctor records.
-If requested, you must, withing 15 business days, provide a health practitioner's disability certificate.
-If requested, you must provide a statutory declaration - a sworn statement describing the circumstances that gave rise to your claim.
-If requested, you may be required to attend an examination under oath, where you will be questioned by the insurance company. If required to do so, we urge you to have a lawyer present to represent you.
THE PRACTICE
Hogan Paralegal Services operates through-out the Halton Region with home courts being Burlington, Milton, Hamilton, and Mississauga. Mr. Hogan also travels through-out the Province as needed.
THE CONTACT INFO
Hogan Paralegal Services
170 Rockhaven Lane
Suite 319
Waterdown, ON L0R 2H6
Call 905-634-2100
Fax 905-634-2199