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Application for Accident Benefits – What You Need to Know

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Application for Accident Benefits – What You Need to Know

Don’t delay discussing your matter with us to find out how to build a winning case.

Please enable JavaScript in your browser to complete this form.

You don’t pay us unless we win your case. No Out of pocket expenses required.

Note: Your Privacy is Safe with us. We will never disclose your information to external parties.
Himelfarb Proszanski Applying for Accident Benefits

If you are injured in a motor vehicle accident you may be eligible for assistance in the form of Accident Benefits (“AB”) under an automobile insurance policy. In Ontario, AB’s 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 (i.e. no-fault benefits).

Drivers of an automobile (i.e. “occupants”) are not the only persons who are entitled to AB’s under an insurance policy. Passengers and pedestrians (including cyclists) are entitled to AB’s (“non-occupants”) as long as there is a nexus between the injuries sustained and the use and operation of the automobile. Family members of a motor vehicle accident victim may also be entitled to AB’s if it can be shown that there is impairment as a direct result of an accident (for instance, psychological trauma). To understand your rights, speak to a lawyer.

Accident Benefits Available

Available AB’s under an insurance policy include:

• Income Replacement Benefits (“IRB”) – Compensates you for loss of your income if you cannot work because of the injuries caused by a motor vehicle accident;
• Medical/Rehabilitation Benefits – i.e. physiotherapy, massage therapy, chiropractic care and renovations made to home;
• Housekeeping Benefits (if it is reasonable and necessary);
• Death Benefits – Payable to a family member who has lost a family member in a motor vehicle accident (includes funeral payments);
• Non-earner / Caregiver benefits – If you do not qualify for IRB’s. (i.e. a student is a non-earner); and
• Attendant Care Benefits – i.e. if seriously impaired and you are required to have a health professional come into your home to attend to your care.

Each of the above benefits are subject to their own rules, requirements and limits. The amount of benefits available to you is also dependent on the classification of your injuries as either “catastrophic” or “minor injuries”.

You must contact and give notice to your insurance company within 7 days after the accident, or as soon as possible, that you intend on making an application for AB’s. The insurance company will then send you the Application for Accident Benefits, which must be returned within 30 days after receipt. Due to the strict timelines for applying for AB’s, it is a good idea to consult with an AB lawyer at your earliest who can assist you through the application process and submit the Application on your behalf.

If you qualify for AB’s, the insurer who first receives a completed application is responsible for paying the benefits.

Covered Under Someone Else’s Policy?

If you have your own automobile insurance or believe that you are covered under someone else’s policy, the completed application will be submitted to that insurance company. If you do not have your own insurance policy, the application will be submitted to your spouse’s insurance company or to the insurance company of the person you are dependent on. If you do not have access to insurance, the application can be submitted to the insurer of the car in which you were an occupant or, if you were a pedestrian, the insurer of the car that hit you.

If you were an occupant of an uninsured vehicle or if you were a pedestrian struck by an uninsured vehicle, the application will be returned to the insurer of any other vehicle involved in the collision. If you believe that there is no insurance company responsible for processing the claim, then you may be able to claim benefits through the Motor Vehicle Accident Claims Fund.

Overall, the application requires you to complete detailed information regarding the accident details, your health information, details of your auto insurance, your employment status and other insurance or collateral payments which may be applicable. After the insurance company reviews your complete application package, you or your AB lawyer will be contacted about the benefits you are entitled to receive and to request any further information which the insurance company requires to assess your benefits. The insurance company may require you to submit further forms and documentation. Some of the forms will require you to visit your family doctor or other health care practitioner, such as a chiropractor, physical therapist or occupational therapist.

Get Help

If a dispute arises with your insurer with respect to entitlement or the amount of AB’s there is a dispute resolution process available through the Financial Services Commission of Ontario (FSCO). The parties can apply for mediation to attempt to settle the matter, or also have the dispute heard at an arbitration. An experienced AB lawyer who is involved with your case from the start can best assure you receive the benefits you are entitled to and guide you through the process.

For more information, visit our section on accident benefits.

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.

Timing is Critical. Help is Free.

Don’t delay discussing your matter with us to find out how to build a winning case.

Please enable JavaScript in your browser to complete this form.

You don’t pay us unless we win your case. No Out of pocket expenses required.

Note: Your Privacy is Safe with us. We will never disclose your information to external parties.

Timing is Critical. Help is Free.

Don’t delay discussing your matter with us to find out how to build a winning case.

Please enable JavaScript in your browser to complete this form.

You don’t pay us unless we win your case. No Out of pocket expenses required.

Note: Your Privacy is Safe with us. We will never disclose your information to external parties.

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Sherene AlySherene Aly
16:02 23 Mar 24
I was very pleased with my decision to retain David and his team for my case. Melissa Gizzo was simply amazing and was able to secure a fair settlement for me.
T TT T
17:46 16 Feb 24
Experienced and excellent law firm. Their lawyers are wonderful, articulate, dilligent, amicable, calm, respectful, responsible, resourceful and have good human and customer relationships Especially DAN HOLLAND 👌 He is an amazing lawyer as regards dealing with any of the Accident case.I was involvedIn an accident in 2019 February. He was God sent as he dutifully and relentlessly worked hard until the case was settled
LizLiz
22:43 18 Jan 24
I highly recommend Dan Holland as a disability lawyer. His commitment to my case made the process seamless. Dan's clear communication and ability to simplify complex legal matters made it easy for me to understand every step. He demonstrated genuine concern for my best interests, making him not only a skilled attorney but also someone easy to talk to.Dan’s support extended beyond legal expertise; he alleviated my stress during the long-term disability case. His calm approach and unhurried demeanour ensured that there was no rush in our collaboration. This, coupled with his dedication, made the entire experience more manageable, fostering confidence in his ability to handle the case with meticulous care.I wholeheartedly endorse Dan for anyone seeking a lawyer who not only gets results but also prioritizes your peace of mind.
Neeshanth SritharanNeeshanth Sritharan
21:49 01 Jan 24
My mom was involved in an accident impacting her daily life and ability to work. Dan Holland has worked with us during the duration of our case and has been helpful in fighting for her and supporting us, and organizing the things we needed. Our family is incredibly grateful of the outcome Dan was able to obtain for us. I would highly recommend him!
Faiza HamidFaiza Hamid
01:26 22 Dec 23
I'm so happy I chose Mena Brar and her team represet us . We could not ask for a better team she is so kind, loyal, and honest. she spoke to me as an equal and made me feel as if my case was definitely important and that I deserved to be fairly compensated. I appreciate you. Did it for me and how this will help me get back on track with my life. keep helping others. You are doing amazing works, Mena Brar. I wish you all the best.
Brenda FurtadoBrenda Furtado
23:38 12 Dec 23
Many thanks to Silene Malhao for settling my husband's TORT claim and to Mena Brar for settling his accident benefits claim. These ladies made themselves available any time we had a question. They were very understanding and compassionate. We were completely taken care of throughout this process. We would definitely recommend this team to friends and family!
ShaunaShauna
15:52 06 Dec 23
We are so happy that we had David and his team represent us. We couldn't have asked for a better team. Not only is David incredibly skilled and experienced, he is kind and compassionate and it is clear how much he cares for his clients. Megan was also absolutely amazing to work with and was always on top of everything and there to answer any questions we had! Thank you!
Andrew CoutoAndrew Couto
23:10 21 Nov 23
I'm so happy I chose David as my lawyer. I spoke to a few lawyers before finding David and I noticed majority of them spoke to me in a way that felt demeaning or that my case wasn't big enough or important enough to take. One phone call with David and my opinion on lawyers changed. He spoke to me as an equal and made me feel as if my case was definitely important and that I deserved to be fairly compensated. The whole process was wonderful. From dealing with David's law clerk Ingrid whom is an amazing and kind woman to his legal assistant Melissa whom is another amazing kind and talented young woman. I was so stressed about this case but from day 1 they helped ease that stress and always answered all my questions promptly and respectfully. I couldn't believe David got me to mediation within 6 months of being cut off my LTD and got me a settlement way beyond my expectations. I can't say enough good things about this law firm but I guarantee you that if you need a lawyer to fight for you David is your guy! . Believe me when I say this is the law firm for anyone dealing with personal injuries especially LTD denial claims. Thank you so much to David, Ingrid and Melissa you truly don't know how much I appreciate all you did for me and how this will help me get back on track with my life. Keep helping others you guys are doing amazing work! I wish you all the best!
Rose RegazziRose Regazzi
21:15 11 Oct 23
I sustained a relatively painful injury, affecting me long term.I wouldn't otherwise had pursued it, as it involved a relatively large corporation, but felt it necessary to do so. However, many lawyers were daunted, with one, who actually referred me to HIMPRO.I was connected with Dan Holland, who reviewed the case, provided with me realistic expectations, sound advice and had a willingness to move forward and represent me.His calm and professional demeanor, brought me to a place of reassurance. His ease in addressing all facets of this process, clearly demonstrated a wealth of experience. There was never any hesitation, when being challenged, and felt my best interest was always in the forefront.This case has since been resolved, to my complete satisfaction.Without reservation, HIMPRO (and Dan Holland, in particular), would be the only firm I would recommend for these type of cases.
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