Ontario’s Statutory Accident Benefits allow for recovery of costs associated with tending to your accident-related injuries. These expenses are covered under the Attendant Care Benefit.
You must submit Form 1: Assessment of Attendant Care Needs in order to recover an attendant care benefit. However, even if you qualify for such a benefit, it may not be so easy to be paid by the insurance company for the service rendered to you.
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Tip 1: Understand the Available Benefits
The Attendant Care Benefit is available to offset the costs of hiring an aide or attendant for residency in a long-term care facility. The amount of available benefits depends on the severity of your injuries.
The guidelines are as follows:
- non-minor injuries – as much as $3,000 per month with an allowable maximum of $36,000 and a time limit of 104 weeks after the date of injury; and
- catastrophic injuries – as much as $6,000 per month with an allowable maximum of $1 million – there is no time limit for benefits.
You may have access to additional Attendant Care Benefits if you elected to purchase such coverage on your policy. Closely examine your policy to determine all available compensation.
Tip 2: Determine if You Qualify for Benefits and at What Level
The Attendant Care Benefit is available only to qualified accident victims. This benefit is not available to those whose injuries have been classified as minor.
The benefit is available to those whose injuries prevent them from engaging in self-care activities such as:
- bathing;
- dressing;
- grooming;
- using the restroom;
- application and removal of prosthetics or use of other assistive devices; and
- eating.
You must enlist a registered nurse or occupational therapist to assess your needs. This professional will then detail the level of care dictated by your injuries. For example, Level One may include basic functions, such as brushing hair or preparing meals. Level Three includes more complex needs, such as performing catheterizations or administering prescribed medications.
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Tip 3: Request only Appropriate Fees and Services
Your insurance provider will closely examine all fees and services outlined in your Form 1: Assessment of Attendant Care Needs. Ensure it details only those costs that are appropriate to your necessary level of care.
For instance, it should not include administration of oxygen therapy if this is not consistent with the care you have been prescribed. Such inconsistencies may result in a delay or denial of your claim for benefits.
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Tip 4: Complete and Submit Forms on Time
The Application for Accident Benefits falls under strict deadlines. For instance, you must notify your insurance carrier of your accident within seven days. Further, you must submit your application for accident benefits within 30 days of receiving the forms from your insurance provider. A failure to meet these deadlines may bar or delay you from recovery.
Tip 5: Consult with a Car Accident Lawyer
A lawyer can provide professional guidance on the completion of Form 1 and all other applicable benefits forms. He or she can help you to present a compelling case for such compensation. Learn more during a free case evaluation. Call 1-800-JUSTICE®.
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