Whether you were a driver, passenger, cyclist, or pedestrian in a car accident, or a witness to one, you are eligible for assistance via the Statutory Accident Benefits Schedule under the Ontario Motor Vehicle Insurance Policy. Some coverage is even available to the immediate family of the injured victim without them even having been involved in the incident themselves.

Have I been in an “accident” as defined by the policy?

As long as the ordinary (and not in any way illegal or improper) use or operation of a motor vehicle is the root cause of why you have become injured, you are likely eligible for assistance under the Accident Benefits (Section B) portion of your Ontario Automobile Insurance Policy. Should you hurt yourself while filling your vehicle with gas, scraping off the ice or even attaching a trailer to it, you are just as eligible for help as if you had been involved in a collision with someone else.

Does fault matter?

NO. If you are in a single vehicle incident by yourself, or if you cause a motor vehicle collision, you are still eligible for assistance. Your coverage(s) may be limited or somewhat curtailed if you are charged with a criminal offence however, and you should consult a qualified legal representative immediately to understand how and what you can do to try and fix the problem.

Whose policy do I go through?

If you are in an accident with a vehicle you use for work, talk to your employer. If it is your personal vehicle, contact your broker or insurance company directly and as soon as possible. If you are a pedestrian, cyclist or a passenger in someone else’s car, you will seek help from your own insurance policy. If you do not have an insurance of your own, you would seek help from the insurer of the vehicle that you were in or one of the vehicle(s) involved that led to your injury (if you are a pedestrian or cyclist). If that information is not given to you by the other party, contact the police whom investigated the accident to obtain a copy of the Accident Report, where that information will be listed. If you are a minor, student or simply dependant on someone else who owns a car, you can also make a claim through that policy (usually your parents or a spouse). If you are a pedestrian hit by an uninsured driver, you can obtain some assistance from Ontario’s Motor Vehicle Accident Claims Fund.

Will making a claim affect my premiums?

NO. Accident Benefit claims are non-ratable by Insurers. DO NOT DELAY in contacting your Insurance Company to tell them of an injury to you or a loved one over fear of your rates going up, as any unreasonable delay could affect your coverage(s). Even if you subsequently need to cancel your policy because your vehicle is destroyed or you can no longer afford it, or if you decide to change insurance carriers, your accident coverage(s) remains preserved regarding the incurred loss.

What kind of assistance is available to me?

Accident Benefits are limited indemnity coverages that, subject to you passing the respective disability test for each benefit type, provide you modest funds for reimbursement of wage loss and for help you need getting well again, both physically and emotionally. You can also obtain domestic and child-care assistance if you are substantially disabled from carrying on with your pre-accident responsibilities and tasks.  Some of the key benefits include :

Specified Benefits such as:

  • Income Replacement
  • Caregiver Benefits
  • Non-Earner Benefits
  • Housekeeping and Home Maintenance Benefits:
  • Attendant Care Benefits:
  • Medical & Rehabilitation Benefits:

Is there an enhanced level of coverage I can access?

YES. You can pre-purchase optional levels of assistance from your insurer to increase your medical/rehabilitation limits, raise your weekly income benefit and index your assistance to inflation so that benefits keep pace with the cost of living. There are other coverage(s) too and you should contact your broker or insurer for a full listing.

Additionally, your accident injuries may be so severe immediately or worsen more progressively over time, such that you are initially identified or later medically determined to be “CATASTROPHICALLY” impaired as defined under the policy. In such instances you gain access to enhanced assistance for a greater duration, notably including: an increase in Attendant Care Benefits up to $6000/month with lifetime access or until $1,000,000 is incurred. Medical & Rehabilitation Coverage available to you past 10 years post-loss and for the balance of your natural life or until you exhaust $1,000,000 in expenses; the right to have a medical case-manager appointed to plan, coordinate and ‘quarter-back’ the provision of services to you; and further extension of Housekeeping and Home Maintenance coverage(s) beyond 104 weeks post loss and for the balance of your life.

What benefits are available for my family?

When you are hurt in a motor vehicle accident the effects are felt by your loved ones too. There are certain benefits designed for people other than the initial victim but if a spouse, sibling, grandchild, grandparent or dependent of the first physically injured person is traumatized to the point that they suffer a psychological or mental injury, they also become eligible for a full range of benefit assistance through their own automobile policy’s accident benefit coverage. This often happens with grave, fatal and grossly upsetting injuries that cause loved ones to miss work, have difficulty functioning in everyday life and need to seek out emotional support through professional counseling.

Visitor’s Expenses can be reimbursed to the immediate nuclear family of the injured person for those reasonable costs they incur in rushing to that person’s bedside be they air, rail or any variety or mode of transport, and can additionally include temporary housing costs (such as hotels) during those visits be they immediately after the accident or for subsequent visits conducted in the first 104 weeks post-loss, when specifically checking in on a loved one whom remains disabled by their accident injuries.

Death & Funeral Expenses are available as limited and immediate compensation and partial indemnity, to deal with the direct, causal loss of life of a loved one in a motor vehicle accident.  Enhanced coverage can be purchased from your insurer to raise the basic limits of up to $6000 in reimbursement for Funeral and related burial costs as well as a $25,000 payment to a surviving spouse as defined under the Insurance Act.  Further payments of up to $10,000 for the loss of a dependent child or legally separated dependant spouse, or conversely $10,000 to each child or dependant, when a parent is killed, are also available as long as the deceased passes from accident related injuries that kept them continuously disabled for that self-same period of no greater than 156 weeks (3 years) post-loss.

Where can I find further information or get help?

While it is the responsibility of the Insurer paying your accident benefits to explain all coverage(s) and provide you with the forms to make claims, the regrettable truth is that such advice is often delivered only in writing and the adjuster is too busy to return your call in a timely way. You can visit the Financial Services Commission of Ontario website (www.fsco.gov.on.ca) for some basic consumer information, but the wealth of forms and procedures can be overwhelming to most healthy people, let alone someone who is suffering the effects from a car accident or struggling to look after an injured loved one.

If you are seeking legal advice, ensure that you talk to a representative that is happy to speak to you without obligation and respond to your questions with straight answers you can understand – no insurance lingo or confusing legalese. Ask the right professionals to help you make fair, timely and appropriate submissions for the assistance you are entitled to so you can concentrate on getting better, and getting back to your life.

Gillis Injury law – Personal Injury Lawyers