Motor Vehicle Accident Benefits Claims

Motor Vehicle Accident
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Did you know that more people have died on Canada’s roads in the last 50 years than the number of Canadians killed in two world wars? In fact, the numbers tell us that on average, eight Canadians die in road crashes every day. Many more are seriously hurt.

In Ontario, all aspects regarding to the motor vehicle accident benefits claims are regulated under the Motor Vehicle Accident Claims Act.

The Statutory Accident Benefits Schedule

When a person is injured in a motor vehicle accident, the Statutory Accident Benefit Schedule (SABS) requires the automobile insurer to pay for non-professional health care services (such as personal support and homemaking services, attendant care services, and community support services). These services may be provided at home or in community settings such as supportive housing units, long-term care homes and complex continuing care hospitals.

Typically, non-professional services can be arranged or provided through local Community Care Access Centres, long-term care homes or other third-party agencies funded by the Ministry of Health and Long-Term Care. Clients who may require these services include those with serious or catastrophic physical injuries, closed head or acquired brain injuries and the elderly.

Automobile insurers should arrange non-professional health services for their clients and pay the service provider directly.

It is only after statutory accident benefits have been exhausted, or the level of service required exceeds specified maximums, that the ministry may consider funding these services, subject to assessment of the client and applicable ministry limits.

The ministry’s subrogation unit is responsible for monitoring compliance of payment responsibility for persons injured in motor vehicle accidents and who require health services. Up to specified maximum limits (e.g. $3000 – $6000 per month and $72,000 per year to a maximum of $1 million if a catastrophic injury for attendant care; $l00 per week for homemaking).

Under the Insurance Act,the Statutory Accident Benefits Schedule is responsible for providing the accident benefits which are available to everyone who has been injured in a car accident, regardless of fault for the collision. If you have had a misfortune of being injured in a motor vehicle accident, you may be entitled to the accident benefits. Please remember, getting financial compensation is anything but simple. The process can be overwhelming even for professionals. If you or your loved ones are injured as a result of motor vehicle accident, you may be eligible for accident benefits. If you have any questions, please contact a lawyer. In most cases, no fee will be charged unless a recovery is made.

The most commonly-accessed accident benefits (but not limited to) are:

  • Income replacement. You are entitled to 80% of your net income to a maximum of $400 per week if you are substantially unable to perform the essential tasks of your occupation or employment during the first 104 weeks. Thereafter, you can continue to receive these benefits as long as you are continuously disabled from any occupation for which you are reasonably suited by education, training and experience for up to $400 a week or 80% of your net income.
  • You may receive non-earner benefits of up to $185 a week if you are not employed. If you suffer a complete inability to carry on a normal life as a result of the injuries from the accident. No benefits are payable under this category for the first six months after the accident.
  • Caregiver costs of up to $250 a week, if you were the primary caregiver of a person in need (with whom you were residing), plus $50 for each additional person in need of care
  • Medical and rehabilitation costs (above OHIP) to a maximum of $100,000 for up to 10 years for a non-catastrophic injury, and up to $1,000,000 for the rest of the victim’s life in the case of a catastrophic injury.
  • Special Attendant Care of up to $3,000 a month for two years for a non-catastrophic injury, and up to $6,000 a month for the victim’s lifetime for a catastrophic injury.
  • Housekeeping and Home Maintenance of up to $100 per week.
  • Death Benefits of $25,000 for the spouse of the victim; $10,000 for each of the victim’s dependents; $10,000 to the person who cared for the victim; up to $6,000 for funeral expenses.
  • Travel Expenses for family members or those living with the accident victim for their visiting costs during treatment or recovery.
  • Lost Education benefits for students to a maximum of $15,000.

You may also be entitled to other benefits, such as payments for lost education expenses, the cost of family visiting you during your treatment, some housekeeping and home maintenance, repair or replacement of eyeglasses or clothing damaged in the accident.

The injured person can also be compensated for the non-monetary aspects of the specific injuries that have affected their life. The legal term for that is pain, suffering and loss of amenity. It could be, for example, loss of enjoyment of life, loss of companionship, disfigurement or inability of doing the type of work that person has done before accident happened (it is called loss of congenial employment), etc. However, it is not easy to win such cases.

In addition, if an injured person believes that the accident was the result of someone else’s negligence, they are entitled to bring a separate lawsuit to recover “tort” compensation.

Even if you feel okay after an auto accident, it would be a good idea to visit a doctor to make sure that there are no any hidden injuries. Mention any complaint you may have, no matter how minor it is.

“No Fault” Auto Insurance

In Ontario, there are significant limits for financial compensation for injuries sustained as a result of a motor vehicle accident, even if you were not an “at fault” driver. At the same time, the system makes available a set of mandatory benefits that insurers must pay to injured parties, including “at fault” operators, passengers in vehicles and injured pedestrians.

The Motor Vehicle Accident Claims Fund

The Motor Vehicle Accident Claims Fund is a branch of the Financial Services Commission of Ontario. The major functions of the Motor Vehicle Accident Claims Fund are:

  • to provide statutory accident benefits directly to persons involved in an automobile accident, who have no recourse to automobile insurance;
  • to provide compensation for personal injury or property damage to victims involved in an automobile accident with an uninsured or unidentified driver or a stolen vehicle when no liability insurance exists; and
  • to recover from the owners and drivers of uninsured vehicles monies paid out on their behalf, where legally permissible

The Motor Vehicle Accident Claims Fund is considered to be the “payer of last resort” as it provides compensation to people injured in automobile accidents when no automobile insurance exists to respond to the claim.

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