Answers to Common Questions about Accident Benefit ClaimsFebruary 08, 2017
If you’ve been involved in an accident, you probably have a lot of questions about which benefits you can claim and how to move forward in accessing them.
Below, you’ll learn the answers to your most common benefit claims questions.
How Do No-Fault Accident Benefits Work?
No-fault accident benefits are available to anyone involved in an accident, including drivers, pedestrians and cyclists, regardless of whether the person is at fault. Even if you were responsible for the accident, you’re entitled to these benefits.
How do I Claim Long-Term Disability Benefits?
If you have long-term disability benefits through your employer, you can still receive no-fault accident benefits. Under Ontario law, you must apply to any other policies before seeking benefits from the no-fault accident insurer, who will then pay you any remaining expenses.
How do I Access Accident Benefits?
Within seven days of your accident, notify your insurance company that you plan to apply for accident benefits. They will send you documents which you must complete and return within 30 days. You will not be able to receive benefits until you have completed and submitted these forms.
What Types of Medical and Rehabilitation Treatment are Covered?
You will be covered for any medical treatment you undergo including physiotherapy, chiropractors and psychologists. You will also be covered for medications, wheelchairs and other kinds of assistive devices, transportation to and from medical appointments, employment training and counseling, and any changes you must make to your home or car due to your condition.
What are the Maximum Treatment Benefits I Can Receive?
Typically, you will be entitled to up to $65,000 for medical treatment benefits. If you have additional coverage, you may be entitled to more. For any catastrophic injuries, you can receive up to $1,000,000 across your lifetime. On the flipside, if you have very minor injuries, your benefit cap may only be $3,500.
What are the Steps to Getting Treatment?
To get treatment, you will need to complete a Treatment Plan insurance form. If a treatment plan isn’t completed by a health professional, you can be denied payment by your insurance company.
What are Attendant Care Benefits?
If you require help doing personal care activities such as bathing, dressing, feeding yourself or other activities, you can receive money to pay someone for assistance. This can include family and friends who helped you while you were hospitalized, or anyone who is a professional support worker or has experienced economic loss due to providing you care. You can receive up to $3,000 per month, up to a maximum of $65,000. For catastrophic injuries, you can receive as much as $6,000 per month, up to a maximum of $1,000,000 without a time limit.
How Do I Get Income Replacement Benefits?
If you were employed or self-employed when your accident happened and you can no longer perform the duties of this job, you are entitled to up to two years of income replacement benefits. If you were not employed when your accident happened and you worked 26 of the 52 weeks prior, but cannot perform the duties of your former position, you can also receive benefits.
This also applies for students, who can receive up to $15,000 in reimbursement if they cannot continue with school. If you are completely unable to work, you may receive these benefits for more than two years. They amount to 70% of your gross weekly income (i.e. before taxes). You can also receive benefits from other sources such as long-term disability. If you try to return to work during the first two years but are unsuccessful, it will simply reduce the amount of your benefits.
Am I Eligible for Caregiver Benefits?
If you were the primary caregiver for another person at the time of the accident, were catastrophically injured, and cannot provide an equal level of care after the accident, you may be eligible for caregiver benefits of up to $250 per week for the first dependent, and $50 per week for any additional dependents.
How do Visitors’ Expenses Work?
If family members or others who lived with you during the accident incurred expenses because of your accident, they can be reimbursed for up to two years.
How Much Can I Receive for Funeral and Death Benefits?
If someone dies in an accident, funeral expenses up to a maximum of $6,000 must be paid by the insurance company. Each of the deceased’s dependants is entitled to $10,000 and the spouse is entitled to $25,000. If the deceased was not married, the $25,000 is divided among the dependants.
It’s a good idea to talk with an Accident Benefits Lawyer after any accident to make sure you get the full compensation you deserve.
Disclaimer: The content of this article is a general guideline made available for educational purposes only and is not intended to be used as legal advice for the reader's specific situation nor in general. By reading our blog and website content, the reader acknowledges the above and understands there is no lawyer-client relationship created between you and Himelfarb Proszanski through this content. To get specific legal advice, we encourage you to book a free consultation with one of our lawyers to clarify the legal aspects of your situation.