A client’s guide to statutory accident benefits after a car crash in Ontario

This article was provided by dNovo Group

In Ontario, Grillo Personal Injury Lawyers suggest familiarization with the applicable provisions in case of a car crash in Ontario – specifically Statutory Accident Benefits (SABS) coverage. SABS is a mandatory no-fault insurance coverage regulated by the Ontario Insurance Act, and can provide financial assistance to drivers, passengers, or pedestrians.

What are Statutory Accident Benefits?

Accident benefits are a part of every car insurance policy. Compensation is offered to those who suffer harm or death as a result of an accident. In Ontario, the SABS prescribes the required and permissible limits for medical treatment, rehabilitation, income replacement, death and funeral expenses, as well as disability-related income loss.

Because statutory accident benefits are a part of Ontario's no-fault auto insurance system, it is available to everyone involved.

What is covered by accident benefits?

Regardless of who is at fault, insurance providers are obligated to provide accident benefits under SABS. What kind, and how long of a benefit is received, may depend on the nature of injuries.

Any accident must immediately be reported to the police, and the injured person should seek medical attention, notify the insurance provider within 7 days, and submit an application for accident benefits within 30 days.

Here are the salient benefits covered:

Medical & rehab

The main benefit is help in covering the price of rehabilitation therapy, medical care, and other medical expenses that are not paid for by either public or private health insurance. Experts at Molson Park Dental say that some dental insurance plans may also cover treatment after a car accident injury.

Here are other items that the benefit could cover:

• Hospital care
• Assistive devices
• Medication, both prescribed and over-the-counter
• Chiropractor services
• Occupational or physical therapy
• Vocational evaluation
• Life skills education
• Career or family counseling
• Dentures
• Prescription glasses
• Additional medical costs

Benefits for a minor injury (bruises, sprains, and strains) could reach up to $3,500 for medical and rehabilitation costs. Those who suffer non-catastrophic injuries (those fit either the Minor Injury Guideline or catastrophic injuries requirements under Section 3.1) may be covered up to $65,000 for medical, rehabilitation, and attendant care costs. Coverage of up to $1M may be available for persons who sustain catastrophic injuries (physical impairment, blindness, amputation, or severe mental or behavioral disorder).

Additionally, it is possible to raise the compensation for non-catastrophic injuries to $130,000, and for catastrophic injuries to $2M.

The SABS outlines the qualified medical services and expenses in Section 15.

Income replacement

Whether the injured person is an employee or a sole proprietor, this benefit can help make up for some of the income they lose while recovering from an accident-related injury.

A basic weekly income replacement benefit is granted to persons who are unable to work owing to injuries sustained, subject to time and income restrictions. If qualified, they should receive 70% of their gross salary, up to a maximum of $400 per week, every two weeks.

Non-earner

A person who sustains a disabling injury but is not eligible for income replacement is given non-earner benefits. These people include individuals who were students or were unemployed at the time of the accident. It is meant to make up for the incapacity to carry out daily tasks normally. Qualified individuals may receive up to $185 per week.

Attendant care

Those who require a caretaker or attendant for rehabilitation, assistance, and supervision, particularly those whose disabilities prohibit them from performing everyday functions such as washing, eating, and dressing, may use this benefit to pay for a caretaker.

Medical, rehabilitation and attendant care benefits of up to $65,000 are available for non-catastrophic injuries, while compensation of up to $1M is provided for the catastrophically impaired. Minor injuries are not covered by this benefit.

Death & funeral

Should the tragic event result in the death of a family member or loved one, the family may be eligible to receive a one-time cash settlement. With this benefit, their spouse receives a payment of $25,000 and each dependent receives $10,000. A maximum of $6,000 is provided for funeral costs.

In Ontario, personal injury claims are often complex and require the services of a lawyer. That is why the Walter Law Group recommends speaking with an experienced legal professional. It has more than 50 years of combined experience in personal injury law and a proven track record of litigating and settling thousands of claims on behalf of clients across Ontario.

A personal injury lawyer can help with the following:

• Explain rights
• Provide advice and consultation
• Investigate claims
• Gather evidence
• Prepare pleadings
• Provide legal representation

About long-term and short-term disability insurances

Short-term insurance gives immediate coverage for temporary incapacity, whereas long-term policies have a longer waiting period, but cover more serious diseases or injuries for a longer period of time.

Many Canadians, however, are having their insurance claims refused. Lack of appropriate medical paperwork, failure to fit the policy's criteria for disability, and evidence obtained via insurance company surveillance are common grounds for denial.

Denied disability insurance coverage claims need to be addressed as soon as possible. The key here is to hire an experienced employment lawyer who knows how the system works and who has a proven track record of overturning claims. To learn more about filing an appeal, please contact Stacey Reginal Ball of Ball Professional Corporation today and learn more about the options available in such situations.