Individuals injured in motor vehicle accidents in Ontario may be eligible for assistance, in the form of “Accident Benefits”, under an auto insurance policy. Consult with a lawyer to understand your rights.
In Ontario, Accident Benefits (commonly referred to as “AB”) are governed by regulation under the provincial Insurance Act, R.S.O. 1990, c.I.8, known as the Statutory Accident Benefits Schedule (“SABS”). Under Ontario legislation, there is a standard auto insurance policy which is required to be purchased by every vehicle owner. This standard auto insurance policy includes a minimum set of AB coverage, designed to provide injured parties with basic necessities, regardless of who caused the accident, such as medical rehabilitation benefits, attendant care benefits, and income replacement benefits. Additional accident benefits coverage may also be purchased in order to customize policies of insurance to suit individual needs. Here is a brief overview of the commonly claimed AB’s provided by Ontario’s standard auto insurance policy (not including additional coverage that may be purchased).
Medical and Rehabilitation Benefits (“MRB”):
This benefit covers reasonable and necessary medical and rehabilitation expenses incurred (i.e. physiotherapy, prescription medication or workplace/home/vehicle modifications) as a result of the accident related injuries that are not covered by a government health plan or a private health plan that you may have through work or your spouse. Here is what you need to know about Medical and Rehabilitation Benefits (“MRB’s”):
• Payment of MRB’s are based on 1 of 3 classifications of your accident related injuries: (i) minor injury; (ii) non-minor injury; and (iii) catastrophic injury
• For minor injuries, such as whiplash, sprains, cuts or bruises, MRB’s are payable to a cap of $3,500
• For non-minor injuries, such as broken bones or internal organ damage, MRB’s are payable for a maximum of 10 years to a cap of $50,000
• For catastrophic injuries, such as amputation of a limb, spinal cord injuries or severe brain damage, MRB’s are payable to cap of $1,000,000
Income Replacement Benefits (“IRB”):
This benefit compensates you for loss of your income if you cannot work because of the injuries caused by a motor vehicle accident. To qualify, you must have been employed, or have been receiving Employment Insurance (“EI”), at the time of the accident. Otherwise, you must have worked at least 26 of the 52 weeks before the accident. Here is what you need to know about Income Replacement Benefits (IRB’s):
• IRB’s are calculated at 70 % of your average gross income based on your employment history
o Your income is calculated as the higher of either (i) the 52 weeks before the accident OR (ii) the 4 weeks before the accident multiplied by 13
o Self-employed income is calculated as the higher of either (i) the 52 weeks before the accident OR (ii) the last fiscal year
o If you are receiving other income replacement assistance, such as short term or long term disability benefits, those amounts are deductable from the amount of your IRB eligibility
• IRB’s are capped at $400 per week
• The first 7 days of your disability are not covered by IRB’s
• IRB’s are payable for a 104 week (2 year) period, but you may be eligible to continue receiving this benefit past the 2 years indefinitely, if after the 2 year mark you are unable to do any occupation for which you are reasonably suited by way of your education, training and experience
• The age 65 marks changes in IRB’s
o If you are already over the age of 65, IRB’s are payable up to 208 weeks and gradually reduced over that period
o If you reach the age 65 while already receiving benefits, the IRB is converted to a lifetime pension at a reduced rate based on an established formula
Non-Earner Benefits (“NEB”):
If you do not qualify for IRB’s, you may be eligible for the Non-Earner Benefit (“NEB’s”) if you suffer a complete inability to carry on your normal activities as a result of the injuries caused by the accident. Here is what you need to know about NEB’s:
• You must be at least 16 years of age and a full time student at the time of the accident, or have completed your education the year before the accident and not yet secured employment
• NEB’s are capped at $185 per week
• The first 26 weeks of your disability are not covered by NEB’s
• NEB’s are payable for a 104 week (2 year) period, but you may be eligible to continue receiving this benefit past the 2 years indefinitely after which point the maximum amount payable increases to $320 per week
• The same age 65 mark changes apply as in IRB’s
Attendant Care Benefits:
If you are unable to carry out personal care activities as a result of the accident (i.e. bathing or dressing) you may receive reimbursement for reasonable and necessary expenses incurred for an aide, attendant or long-term care facility to assist you with such personal activities. Here is what you need to know about Attendant Care Benefits:
• Your accident related injuries must not be considered a “minor-injury”
• If your accident related injuries are considered to be “catastrophic” the benefit is capped at $6,000 per month to a total of $100,000
• If your accident related injuries are not considered to be “catastrophic” but are also severe enough not to be found as “minor injuries” then the benefit is only payable for a 2 year period and is capped at $3,000 per month to a total of $36,000
Caregiver Benefits:
If you were a primary caregiver at the time of the accident, but cannot continue that role due to catastrophic injuries suffered as a result of the motor vehicle accident then you may receive reimbursement for expenses incurred to have someone assist in the caregiving. Here is what you need to know about Caregiver Benefits:
• Caregiver Benefits is capped at $250 per week for the first person in need of care and $50 per week for each additional person in need of care for whom you were the main caregiver
• This benefit is payable for a 104 week (2 year) period, but you may be eligible to continue receiving this benefit past the 2 years indefinitely if after the 2 year mark you are completely unable to carry on a normal life
For more information, visit our accident benefits section. If you have any questions, book a free consultation or call 1-855-446-7765 for immediate assistance.
