Motor vehicle accident victims in Ontario typically are eligible for Statutory Accident Benefits. This includes a Medical and Rehabilitation Benefit, as well as other compensation to assist in the care of an injured victim.
These benefits are particularly crucial for a victim who has suffered traumatic brain injury. Understanding the Statutory Accident Benefits Schedule (SABS) and other factors related to brain injury may help you better protect your or your family member’s right to benefits.
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How Misclassification of Injury Can Cost Valuable Benefits
It is essential that your loved one’s brain injury is correctly classified after an accident. The three “levels” of injury are:
- non-minor; and
The Ontario Insurance Act and other legislation very narrowly define catastrophic injuries as those involving spinal cord trauma, traumatic brain injury, amputation or certain other debilitating injuries. This does not mean, however, that all brain injuries automatically qualify as “catastrophic.” Your Application for Accident Benefits must make a strong case for the classification of non-minor or catastrophic injury.
A victim whose injuries are misclassified may miss out on vital Accident Benefits or have a limited timeframe in which to receive owed benefits. For example, the amount of a victim’s Medical and Rehabilitation Benefit hinges on the category of injury:
- as much as $1 million for catastrophic injuries;
- as much as $50,000 for non-minor injuries; and
- just $3,500 for minor injuries.
Other benefits and compensation also depend on the classification of injury. For example:
- Travel expenses – An insurer may pay expenses incurred when a claimant with catastrophic injuries must travel for medical examinations. Those with non-minor injuries only receive reimbursement when travel is in excess of 50 kilometres, and only then, for the distance traveled beyond 50 kilometres.
- Attendant Care Benefit – This benefit is available only to those with non-minor or catastrophic injuries. The compensation seeks to offset the cost of hiring an in-home nurse or providing for extended care in a live-in facility. Those with catastrophic injuries have no time limit on this benefit, while those with non-minor injuries are limited to 104 weeks after the accident. The monthly quantum also varies between non-minor and catastrophic injury.
- Housekeeping or home maintenance – This benefit is available only to those who have injuries classified as catastrophic or who purchased the additional coverage on a policy.
These are just a few examples of the financial significance of ensuring a correct classification of injury. A misclassification can be a costly mistake and one that can go undetected without the assistance of a personal injury attorney.
What a Lawyer Can Do to Advocate for Fair Benefits
The SABS requires substantial medical evidence before classifying a brain injury as non-minor or catastrophic. An Ontario lawyer will understand the criteria used in making such a classification. He or she can work in coordination with medical providers to collect evidence necessary to support an Application for Accident Benefits.
A lawyer can examine your claim to assess any weaknesses, such as unsupported expense claims or insufficient medical evidence. Further, a lawyer can appeal an Accident Benefits Package that provides insufficient medical care and rehabilitation compensation to treat your family member.
Call the Preszler Law Firm toady at 1-800-JUSTICE® to learn more about what you can do to protect your loved one’s right to Accident Benefits.