What You Should Know About Attendant Care Benefits in Ontario
Attendant Benefits are defined by regulation: the Statutory Accident Benefits Schedule (SABS). This compensation is offered in cases where an accident victim can show reasonable cause for requiring attendant care services. The benefits are intended to assist a victim in improving his or her health after sustaining injury.
Below is a guide to better understanding the Attendant Care Benefit and what it can provide for you.
What does the Attendant Care Benefit cover?
The Attendant Care Benefit can be used to pay for “reasonable and necessary” expenses incurred when hiring someone to help you care for yourself after an accident.
The benefit covers professional services such as:
- in-home care from a personal aide or attendant; and/or
- convalescent care in a long-term care facility (such as a home or chronic-care hospital).
These services are most typically needed when an accident victim’s injuries prevent self-care.
This may include such activities as:
- preparing meals/eating
- using the restroom
Attendant Care Benefits cover only those expenses necessary for healthy and comfortable personal care. Other categories of Accident Benefits address services such as housekeeping (which is an optional benefit) and performing errands.
How much money is available for Attendant Care Benefits?
The amount of available Attendant Care Benefits and duration of payment depends on the nature of your injuries.
The breakdown is as follows:
- as much as $3,000 per month for non-minor injuries for a total of $36,000 (which will be paid for a maximum 104 weeks from the date of the accident); and
- as much as $6,000 per month for catastrophic injuries for a total of $1 million (there is no time limit).
The figures listed above correspond with standard, mandatory Accident Benefits. You may elect to pay a higher monthly premium for additional coverage. Examine your policy to determine if you qualify for higher coverage levels.
Am I eligible for Attendant Care Benefits?
You may be eligible for Attendant Care Benefits if your injuries have been categorized as “non-minor” or catastrophic. You are not eligible for Attendant Care Benefits if your injuries have been classified as minor.
A registered nurse or occupational therapist will determine whether attendant care services are necessary and how much care is appropriate for your needs. This professional will complete an Assessment of Attendant Care Needs (otherwise known as Form 1) as verification for your insurance provider. This form must then be sent to your insurance provider.
Your insurance company has 10 business days in which to respond to the Assessment of Attendant Care Needs. Your insurance company must provide reimbursement for expenses within 30 days of receipt of invoices – provided the company accepts that the services are necessary and reasonable. If a professional service provider renders the services, the insurance company will generally pay the provider directly. However, if a family member or non-professional renders the attendant care services, the person rendering the services will have to demonstrate that an economic loss was sustained in order to perform the services. Be aware that an insurance company may dispute or deny a request for Attendant Care Benefits.
How much time do I have to apply for Attendant Care Benefits?
You must report your accident to your insurance provider within seven days of incident. You must then submit your Application for Accident Benefits within 30 days of receipt. The insurance is generally not liable to pay for attendant care services until such time that an Assessment for Attendant Care Needs (Form-1) is completed and filed with the insurance company.
Get started today by downloading auto insurance claim forms. Or, for personalized assistance with your application, call Preszler Injury Lawyers at 1-800-JUSTICE® to schedule a free case evaluation.