Accident Benefits… Who Knew?

Unknown to many, provincial legislation exists which allows individuals to make claims for injuries sustained during an automobile accident, regardless of which party is held liable. Under Ontario’s Insurance Act, regulation 34/10 The Statutory Accident Benefits Schedule (SABS), outlines the various benefits that one may be eligible to receive.

Who is Eligible?

The individual who was injured along with dependants and close relatives in certain circumstances, are eligible to receive accident benefits. However, individuals who acted in violation of the law will not be eligible for such benefits. This includes but is not limited to driving without a valid license or insurance policy, using the automobile for criminal activity and driving while impaired.

Types of Benefits

Here is a list of the various types of benefits one may be eligible to receive under SABS. Please note that while individuals may be eligible for more then one type of benefit, only one type can be claimed.

Income Replacement Benefits – will partly compensate individuals for lost income because of the injuries sustained in the automobile accident. Individuals can receive up to 70% of their gross income at the time of the collision, with a maximum of no more than $400 per week for 104 weeks.

Non-Earner Benefits – For individuals who are unable to live a normal life as a result of the accident, and do not fall under those eligible to receive income replacement benefits. Individuals must be at least 16 years of age, and a full time student at the time, or had previously finished school within the last year but hadn’t found employment in their field. Individuals will be entitled to receive up to $185 weekly for 104 weeks. After 104 weeks, the amount increases to $320 weekly if still eligible.

Caregiver Benefit – For individuals who are unable to carry out their caregiver role (taking care of dependants) because of injuries incurred during the accident. Individuals must, be living with the dependant at the time, be the primary caregiver, and receive no payment for the care they provide. Can receive $250 weekly for up to 104 weeks for the first dependant, and any additional dependent is an added $50 weekly.

Medical and Rehabilitation Benefits– Reimburse individuals for expenses incurred as a result of the injuries one sustained in a motor vehicle accident, that aren’t otherwise covered in an alternate health plan (such as OHIP). Amounts awarded vary depending on the severity of injuries.

Attendant Care Benefits– To compensate those who are no longer able to care for themselves and therefore must seek out the services of another.

Death and Funeral Payments Benefit- The death benefit is a lump sum given to those individuals who have lost a spouse, dependent or caregiver. Funeral Payments Benefits will provide individuals with a reimbursement for funeral costs.

Other Expense Benefits – Beyond those mentioned above, individuals might be eligible to receive benefits for lost education, home maintenance/housekeeping, visitor benefits amongst others.

How to Apply?

Individuals must first report injuries incurred during the accident separately from any claims for damage to property. Insurance companies must be notified that you wish to apply for accident benefits within 7 days of the accident. Once notified a package from the insurance company containing various forms, is delivered to the applicant for their completion. This package must be completed and returned to the insurance company within 30 days of receiving it. Within 10 days, individuals will be notified of the insurer’s decision to award accident benefits. Decisions could include, approvals for benefits, request for more information or request for an insurer examination (Completed by a regulated health professional chosen by the insurance company for the purpose of conducting a file review or examination to get a second opinion on one’s condition).

If you are looking for further detail, this accident benefits brochure provides a great overview.

If you do wish to pursue a claim it is advised that you seek independent legal advice from a licensed paralegal or lawyer to assist you in the matter.

Stephanie Hannah is a Paralegal student at Centennial College in Toronto studying professional communications with Omar Ha-Redeye.

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