An Ontario Accident Victim’s Guide to Income Replacement Benefits

Ontario’s Statutory Accident Benefits Schedule provides some monetary relief for car accident victims who miss work because of their injuries. This financial benefit is offered through your settlement in the form of income replacement benefits.

Income replacement benefits are available to victims whose accident-related injuries prevent them from working at all or at the same level they did prior to the accident. This disability may arise as a result of physical or emotional impairment, such as debilitating back pain or post-traumatic stress disorder.

Below, we answer some of the most common questions about this important benefit.

• You must meet several qualifications to be eligible for Income Replacement Benefits in Ontario, including being injured severely enough that you cannot work the same way you did before your injury. Non-earner benefits also are possible if not all category requirements are met.
• Your Income Replacement Benefits are calculated based on gross income, are paid every two weeks, and do not exceed $400 per week. You may be eligible to receive payment for past and future income loss beyond these benefits by filing a slip and fall or other personal injury claim. A lawyer can also help you determine any other deduction of benefits.
• Income Replacement Benefits are paid at their maximum for up to 104 weeks. For the first seven days of disability, any lost income is not covered.
• You must inform your insurance carrier within seven days of your accident and also fill out an OCF-2 form. A completed application for Income Replacement Benefits must be submitted within 30 days, otherwise you may lose out on benefits. Contact a disability lawyer for assistance.

Am I eligible for Ontario Income Replacement Benefits?

To be eligible for income replacement benefits, an applicant must have severe enough injuries that they cannot work or cannot work in the same way they did before being injured. They also must meet one or more of the following qualifications:

• employed at the time of the accident (including self-employment);
• worked for 26 or more weeks out of the 52 weeks preceding the accident;
• receiving Employment Insurance at the time of the crash; or
• not employed but at least 16 years old and excused from attending school at the time of the crash.

Note: An applicant who meets one of these categories may instead be classified as a non-earner, if they choose to receive these benefits instead of Income Replacement Benefits.

How much money will I receive to cover my lost wages after an accident?

You may receive payments to cover as much as 70% of your gross weekly income. This figure will be based on your employment history just prior to the crash. Benefits are paid at least every two weeks but may not exceed $400 per week.

If you were employed at the time of the crash, your benefits generally will be calculated based on:

• your gross income in the 52 weeks prior to the crash; or
• your gross income in the four weeks preceding the crash, multiplied by 13.

Your final benefit amount will be reduced in accordance with any other source of income replacement you receive. This may include income assistance rom an employer or other insurance policy.

Carefully review your auto insurance policy to determine if you elected and paid for additional Income Replacement Benefits beyond the statutory minimums.

Calculating Past Income Loss

If you are involved in a motor vehicle accident and have to take time off work after an injury, you can recover money for the days that you missed. However, you will not receive any compensation for the first 7 days following an accident. This does not apply for other injury claims. In those claims, like slip and falls claims, you are entitled to all lost income from the date of the accident onwards.

In motor vehicle accident claims, accident benefits coverage will provide you with Income Replacement Benefits up to a maximum of $400 per week; however, those benefits are not payable for the first seven days immediately following the accident. The difference between the $400 per week and what you would ordinarily earn can be sought from the at-fault party. Unfortunately, under the current legislative framework, you can only receive a total of 70% of your gross income prior to the collision until the trial date if suing the at-fault party. The at-fault party will also get credit for all income or Income Replacement Benefits paid by the accident benefit carrier or from any other source that provides income continuation like CPP or short- or long-term disability insurance.

To calculate how much money you should receive for past income loss, a court will look at:

• your past paycheck stubs;
• tax returns;
• bank account statements; or
• other documents that prove what you were previously earning.

Payments for Future Income Loss

Accident victims may be entitled to file a lawsuit against a negligent driver responsible for the collision in addition to collecting no-fault accident benefits. While they may recover 70% of gross earnings until the trial date, they may recover 100% of gross income loss and earning capacity after the trial.

A completely disabled person who is 20 years old will receive more compensation for lost future income than a person who is 60, because the 20-year-old has more working years left, while the 60-year-old is approaching retirement. To calculate your future income, an expert may analyze factors like your career trajectory and predictable raises, or your ability to change jobs or begin a new profession.

Deduction of Other Benefits

In general, the amount you receive in either past or future income loss damages relating to motor vehicle accidents will be reduced by income you receive from other sources. The person or entity responsible for paying your damages is usually entitled to deduct any other benefit amounts from the amount of your lost future or past income like:

• short- and long-term disability payments;
• Canadian Pension Plan; or
• Income Replacement Benefits.

For slip and fall claims, the at-fault party may receive credit for income received from other sources but only under certain circumstances. A lawyer can help determine those circumstances.

How long will my Income Replacement Benefits continue after injury?

You may receive your maximum level of income replacement benefits for up to 104 weeks after the point of disability. At 104 weeks and beyond, you may receive a minimum weekly benefit of $185, provided you still meet the disability qualifications. Unfortunately, your lost income is not covered for the first seven days of disability.

While damages for past income loss are relatively straightforward to calculate, determining the correct amount of future income loss tends to be a major source of conflict between an accident victim and the person paying the damages. Often, experts are required to analyze your potential for future income, especially in the case of younger individuals who are disabled and stand to lose a lifetime of working.

What must I provide in order to receive Income Replacement Benefits, and when?

Your application for benefits should include a completed Employer’s Confirmation Form (OCF-2). This document includes information about your weekly income, including tips, salary, and other compensation.

You must inform your insurance carrier of your accident and injuries within seven days of the incident. You must submit a completed application for benefits within 30 days of receipt. A failure to meet these deadlines could disqualify you for full payment of the benefits owed to you.

Learn more about what you can expect from accident benefits by scheduling a free case consultation with Preszler Injury Lawyers in Ontario. Call our offices at 1-800-JUSTICE or fill out our online case evaluation form.