Accident Benefits in Ontario: What You Need to Know -1-800-JUSTICE®

This video provides an overview of accident benefits available to individuals injured in motor vehicle accidents in Canada, commonly referred to as the Statutory Accident Benefits Schedule (SABS). It explains the types of vehicles covered, the application process, and the importance of adhering to specific timelines for notifying insurance companies. Viewers will learn about the different levels of coverage under standard policies, including income replacement and medical treatment benefits, as well as the implications of being classified under the minor injury guideline. The video emphasizes the necessity of legal assistance from firms like Preszler Injury Lawyers to navigate the complexities of accessing benefits and disputing any denials from insurance companies. For more information, contact Preszler Injury Lawyers at 1-800-JUSTICE.

Accident benefits are commonly referred to as the statutory accident benefits schedule, often abbreviated as SABS. Anyone injured in an accident involving a motor vehicle has access to these accident benefits through a motor vehicle insurance policy. The term "motor vehicle" is often debated and includes cars, motorcycles, trucks, snowmobiles, ATVs, and, in certain circumstances, buses.

Individuals injured in an accident can access these benefits, but there is a specific framework for how a person can gain access. Additionally, there is a specific schedule that dictates which insurance policy to apply to. For instance, injuries involving pedestrians or passengers of a vehicle may not have their own insurance policy, so the law establishes a priority for how a victim of an accident can access accident benefits.

There is also a specific timeline that must be followed to access these benefits. Firstly, you must notify the insurance company of your intention to apply within seven days following an accident. After that, you have 30 days to file the formal application for accident benefits with the insurance company. Generally, you have 30 days from the date you receive the application. The process is structured so that you must request certain benefits from the insurance company; they are not automatically offered.

What does a standard policy provide? There are actually three different levels of coverage. Most people believe that when they sign up for their motor vehicle insurance policy, they receive the standard policy. This standard policy includes an income replacement benefit of up to a maximum of $400 per week, calculated based on 70% of your gross income. It is important to note that there is a different test for self-employed individuals.

Regarding medical treatment, the standard policy indicates that the starting point is $65,000 worth of coverage for both medical and rehabilitation expenses, as well as attendant care. However, many people do not realize that the insurance company can unilaterally determine that you have what is considered a minor injury. If they classify you under the minor injury guideline, your coverage may be reduced to $3,500, regardless of whether you initially believed you had $65,000 worth of coverage. After reaching this limit, the insurance company will not provide further funding, even if you have not fully recovered.

The third layer of coverage is reserved for those who are most seriously injured, referred to in legislation as catastrophically impaired individuals. Under the standard policy, a catastrophically impaired individual can receive up to one million dollars worth of coverage over their lifetime. This also unlocks additional benefits that would not be available under the standard policy of $65,000 or the minor injury guideline, such as housekeeping and home maintenance assistance of up to $100 per week.

Attendant care is a form of treatment that can be provided by a personal support worker, a nurse, or, in some cases, family members. This care is often necessary following surgeries or due to serious impairments, where you require assistance with various aspects of your activities of daily living, such as bathing, grooming, laundering, and transferring. Under the standard policy of $65,000, the maximum you can receive for attendant care is $3,000 per month. If you are catastrophically impaired, you can receive up to $6,000 per month. There are specific rules governing how you access these benefits, which is why it is advisable to have a lawyer or a law firm assist in coordinating this type of treatment. They can ensure that you have the right healthcare practitioners involved in your case, allowing you to access all of your benefits.

Additionally, when you purchase your policy, you have the option to buy additional benefits, known as optional benefits. For instance, if you earn more than $20,000 or $30,000 a year, you should consider purchasing an increased income replacement benefit. Optional benefits can allow you to increase your income replacement benefit from $400 to $600, $800, or even $1,000 per week, but you will need to pay extra for this coverage. The same applies to medical treatment, where you can increase your benefits from $65,000 to one million dollars. Other benefits, such as caregiver benefits and visitor benefits, are also available.

It is crucial to contact a law firm to understand your full entitlements and coverage. Most importantly, if an insurance company begins to deny various requests for treatment or recommendations made by your healthcare team, a law firm can intervene. They can ensure that the insurance company is well informed about the reasons you need the treatment you require. If the insurance company continues to deny your claims, the law firm can take steps to dispute the denial of your benefits through the legislative framework that exists in Ontario.

If you or a loved one has been injured in a motor vehicle accident and is experiencing issues with your accident benefit carrier, or if you simply need to apply for accident benefits, Preszler Injury Lawyers can assist you from start to finish. We will help ensure that you gain access to all the benefits you require.