Caregiver Benefits

Many people in Ontario serve as full-time, unpaid caregivers for children, aging parents, or dependents with disabilities. When a serious motor vehicle accident makes it impossible to continue providing the care that they were providing before, families can be left without critical support.

In Ontario, the Statutory Accident Benefits Schedule (SABS) provides Caregiver Benefits to help cover the cost of hiring someone to perform your daily caregiving duties when you cannot. Without this type of support, many dependents may be left vulnerable, and families could be overwhelmed.

Sometimes, insurance providers will try to deny or delay the Caregiver Benefits you deserve after an accident. At Preszler Injury Lawyers, our Accident Benefits lawyers can help you pursue the coverage your family needs while you recover. Contact us today to schedule a free consultation and discuss your legal options.

What Are Caregiver Benefits and Who Qualifies For Them in Ontario?

Caregiver Benefits are meant to provide financial assistance to hire help when an accident victim can no longer perform their caregiving responsibilities for dependents in their household. It’s important to be aware of the distinction between Caregiver Benefits and Attendant Care Benefits when it comes to coverage under the SABS:

• Caregiver Benefits: Pay to replace the person who performed caregiving duties when they are injured in an accident.
• Attendant Care Benefits: Pay for a caregiver for the injured person directly.

Under standard SABS policies, eligibility for Caregiver Benefits:

• Is only available if the claimant suffers a catastrophic impairment injury, such as paraplegia, quadriplegia, a traumatic brain injury (TBI), major amputation, etc.
• Must be claimed by the primary unpaid caregiver who lives with dependents at the time of the accident. If additional caregivers exist in a part-time capacity, they may not be eligible for Caregiver Benefits.
• Cannot be claimed if you are already receiving Income Replacement Benefits or Non-Earner Benefits.

You may elect to purchase additional coverage through your individual auto insurance policy. Should you do so, your Caregiver Benefits through the SABS may also cover serious, but not catastrophic, injuries. This may make coverage more accessible, depending on the accident and injury in question.

How Much Do Caregiver Benefits Pay and How Long Are They Payable?

Under the SABS, the standard amount for Caregiver Benefits is $250 per week for the first person in need of care. For each additional dependent that the original caregiver provided for, an extra $50 is available per week. For example, if you are a caregiver who supported two elderly parents and a child with a disability before your accident, you may be eligible for up to $350 per week.

The purpose of Caregiver Benefit payments is to cover the costs of hiring someone to provide the care you once performed yourself. To qualify for these payments, you must be able to demonstrate the severity of your injuries and their impact on your ability to perform your caregiving duties.

Initially, Caregiver Benefits are payable for up to 2 years (104 weeks) after the accident if you are unable to resume your caregiving duties before this time limit elapses. After 2 years, to continue receiving benefits, you must be able to demonstrate a complete inability to carry on a normal life, as defined under s. 3(7) of the SABS.

To do so, you will have to prove that the impairment you sustained in your accident continuously prevents your participation in all pre-accident caregiving activities. When assessing your “complete inability” status, insurance adjusters will consider not only your ability to perform tasks, but also the quality of your participation and whether pain or other impairments get in the way.

The Application Process for Caregiver Benefits in Ontario

To receive Caregiver Benefits in Ontario, there are several steps you must take:

• Step 1: Notify your insurance provider of your intent to claim Caregiver Benefits within 7 days of the motor vehicle accident occurring.
• Step 2: Complete and submit your Application for Accident Benefits, also called the OCF-1 form, within 30 days of receiving it from your insurer. You may need to complete additional forms required by the Financial Services Regulatory Authority of Ontario (FSRA), such as the OCF-10, and more.
• Step 3: Provide documentation proving your eligibility, including:
  • Proof of the dependent(s) requiring care
  • Medical evidence of your catastrophic or serious impairment
  • Confirmation of your primary caregiving role prior to the accident (e.g., affidavits, school/daycare records, household structure evidence)

A dedicated Accident Benefits lawyer will be able to advise you on the type of evidence you should gather and help you collect it in a timely manner.

Strict deadlines apply to Caregiver Benefit applications in Ontario. It’s important that you stay aware of time limits and submit your claim before they elapse. Failure to provide full documentation on time can result in a denial of your benefits altogether.

Contact Preszler Injury Lawyers For Help Claiming Caregiver Benefits in Ontario Today

Although Caregiver Benefits can be a critical resource for injured individuals who have dependents relying on them, sometimes it is challenging to receive coverage. Insurance adjusters may try to argue that your injuries are not catastrophic, disagree about your status as a primary caregiver, or deny you if you’ve claimed another Accident Benefit. 

At Preszler Injury Lawyers, our legal team is committed to helping motor vehicle accident victims pursue the benefits they need to recover. We will help you:

• Gather and present strong evidence of your catastrophic impairment.
• Prove your caregiving role through testimony, documentation, and other records.
• Ensure you meet important deadlines and all your applications are filled out correctly.
• Challenge any denials by your insurance company through the Licence Appeal Tribunal (LAT).
• Advise you on whether other benefits may be available to you, depending on your situation.
• And more.

If you or a loved one can no longer provide essential caregiving duties after a car accident, our law firm can help. Contact us today for a free consultation. You can call our offices in Ontario at 1-888-608-2111 or fill out our online contact form now.