Accident Benefits Law FAQ

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What are accident benefits?

If you’ve been involved in an accident and are injured, you may be entitled to financial benefits that will help support your recovery. Accident benefits are standardized across insurance companies provincially and are known in Ontario as the Statutory Accident Benefits Schedule (SABS). These benefits provide compensation if you, passengers, or pedestrians are injured in an accident regardless of who is at fault.

It’s important to keep in mind that accident benefits and claiming for damages to personal property are two separate processes. If you are in an accident, report your injuries to your insurer within seven days of your accident. After you report your injuries, your insurer will send you an Application for Accident Benefits form. This form must be completed within 30 days from the time you receive it. If you don’t complete the form within 30 days, you have to provide a reasonable explanation regarding why the form was not completed.

Relatives that have experienced expenses as a result of your accident may also be entitled to accident benefits. It’s advised to speak to an accident benefits lawyer as soon as possible to understand if you have a case and how to proceed with the insurance company.

What if the person who caused the accident has no insurance?

In situations like these, where an at-fault driver has no insurance, or you were a victim of a hit and run, you have access to the uninsured motorist coverage provided by your insurance policy.

The Ontario Insurance Act section 265 legislates that all people must have uninsured coverage. This means that every insurance contract or policy must have coverage for injuries caused by uninsured and unidentified drivers.  This is known as “section 265 coverage”.

If a situation arises where the other driver is uninsured, or you are involved in a hit and run and the at-fault driver is unknown, your insurer steps into the shoes of the uninsured or unidentified driver and the amount recoverable is normally limited to $200,000.00, although there may be additional insurance under your policy in some cases. Further, an injured party cannot claim against his or her own insurer if the person is entitled to recover money under the third-party liability of any other motor vehicle liability policy.
Section 265 coverage compensates victims of motor vehicle accidents for their injuries by uninsured or unidentified drivers and is different and apart from underinsured claims for inadequately insured drivers.

What if I was driving my car without car insurance and was involved in an accident?

Ontario law requires that all motorists have auto insurance.
Fines for vehicle owners, lessees and drivers who do not carry valid auto insurance can range from $5,000 to $50,000.
If you are found driving without valid auto insurance, you can have your driver’s license suspended and your vehicle impounded.
If you are convicted of driving without valid auto insurance, your next insurance company may consider you a “high-risk” driver and charge you higher premiums or refuse to sell you insurance altogether.

If you are injured in an accident while driving or occupying an uninsured vehicle:

  • you may not be entitled to receive income replacement and/or non-earner benefits;
  • you may not be allowed to sue the at-fault driver for compensation as a result of injuries received in the accident.

More importantly, if you are found to be at fault for an accident causing injury or death to another person, you may be held personally responsible for his/her medical costs and other losses.

What if the person who is injured can’t make a decision due to mental incapacity?

A family member can help the injured person make decisions regarding treatment while the injured person is hospitalized, while a lawyer can help them with the legal process.

I have been asked to complete many complicated insurance forms. Will someone help me complete my accident benefits form?

We don’t recommend completing the insurance forms on your own as they are complicated and should be completed by an experienced professional to make certain there are no errors or omissions of critical information. Our lawyers are experienced in accident benefits and will ensure that your forms are filled out correctly to make certain that your rights are protected.

What are the Benefits that are Available from my Insurance Company?

There are two categories of benefits that are available to you, known as “Non-Catastrophic” and “Catastrophic” benefits.

Non-Catastrophic Benefits:
For non-catastrophic benefits, you may be entitled to up to $50,000.00 for medical and rehabilitation expenses for up to 5 years. In terms of attendant care, the maximum is $36,000.00 in total, or up to $3,000.00 per month until the maximum of $36,000.00 is reached. In terms of income replacement, you can receive 70% of your gross income, up to $400.00 per week. If you are not earning an income, you can receive up to $185.00 per week. Your visitors are also entitled to visitor expenses for two years. If death occurs, there is coverage for funeral benefits of up to $6,000.00, while a spouse and dependents may be entitled to benefits.

Catastrophic Benefits:
For catastrophic benefits, you may be entitled to up to $2,000,000.00 combined for medical and rehabilitation expenses and attendant care. In terms of attendant care benefits, you can receive up to $6,000.00 per month. There is also coverage for housekeeping of up to $100.00 per week, and visitor expenses for life. Additional benefits include caregiver benefits, income replacement benefits, non-earner benefits, death benefits and funeral benefits. You also may be entitled to rehabilitation case manager services.

What forms of compensation are available from the person who caused the accident?

The person who caused the accident is responsible for paying compensation for all losses and expenses that you have experienced. These expenses and losses may include pain and suffering, loss of income, lost working years, medical and rehabilitation costs, attendant care, housekeeping, medical device and medication expenses, as well as family member compensation for loss of care and their expenses associated with your accident.

I have been sent Accident Benefit Forms by my Insurance Company. Should I Complete these forms before talking to a Lawyer?

We recommend speaking to a lawyer before completing any forms. The forms ask questions that are sensitive and need to be answered accurately to protect your rights. Your lawyer will assist you in completing the forms, so there is no delay in accessing benefits.

What should I do if the insurance company refuses to pay benefits?

Your consultation is free and when your case is settled, legal fees are paid from the settlement based on a percentage agreed to at beginning of your lawsuit. We pay for all expenses, known as “disbursements”, such as medical, accounting and other experts. Then, we are reimbursed when your case is settled. If a lawsuit is not successful, you are not charged for legal fees or any expenses.

It’s important to discuss legal fees with your lawyer. Most personal injury lawyers work on a contingency fee retainer, which means that the lawyer gets paid a percentage of your recovery when the case is settled and you receive compensation. This means that if you do not receive money for your injuries, your lawyer does not get paid.

What if my injuries prevent me from working?

You can claim loss of income and receive income replacement benefits, which will pay 70% of your loss of income up to a maximum of $400.00 per week. You may also be eligible for short-term and/or long-term disability benefits, as well as a disability pension through the Canada Pension Plan.

What benefits am I entitled to if I’m not working?

If you were the primary caregiver for someone in your home prior to your accident and you are no longer able to continue providing care, you may be entitled to caregiver benefits of $250.00 per week. In addition, you may be entitled to $50.00 per week more for every additional person you were taking care of before the accident occurred. If you are not the primary caregiver for someone in your home, you may be entitled to non-earner benefits of $185.00 per week.

What if I can’t work or look after my children?

Accident benefits through your insurance company are available to cover some of your expenses. If you can’t work, you are entitled to 70% of your income up to a maximum of $400 per week. For catastrophic injuries, if you are the primary caregiver of someone in your home, you may be entitled to $250 per week for the first person you were looking after, and $50 for every other person you were taking care of prior to your accident.

Here’s What Our Clients Say

  • Often the public perceives lawyers in a negative way; but I can honestly say that David Himelfarb has the utmost ethical standards of any lawyer that I have dealt with. He took the time to explain the particulars of my case, was always available to take my calls, always returned my calls and his team of Clerks and Assistants were equally as professional and courteous. Should I ever need legal representation, I can assure you that I will retain his firm.

    Adina Williams

  • My no fault benefit claim was handled by the firm and was settled quickly and for a very good amount. The firm is extremely professional and dedicated. I would highly recommend the firm to anyone who has been involved in a serious accident.

    Victoria A. - Toronto, ON

  • I would like to extend a sincere thank you for your assistance regarding the legal issues and my claim for disability benefits. Your knowledge and expertise led to a quick resolution and a successful outcome. From the onset, you were honest with me about my case and yet always kept me in the loop as to what was going on. I appreciated your “up front” approach from our first meeting.

    Mike Elliott

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