Income Replacement Benefits in Ontario -1-800-JUSTICE®

This video explains the income replacement benefit available to accident victims in Canada, detailing the eligibility criteria and benefit amounts. To qualify, individuals must have been employed at the time of the accident, have worked for 26 of the 52 weeks prior, or be receiving Employment Insurance. The maximum benefit is $400 per week, calculated as 70% of gross income for those employed. Additionally, a non-earner benefit is available for those not working, providing up to $185 per week after a four-week waiting period. The legal test for benefits changes after two years, often leading to claim denials as insurers assess the ability to perform any job. For further assistance, contact “Preszler Injury Lawyers” at “1-800-JUSTICE” or consult with “Jeffrey Preszler”.

Following an accident, an accident victim does have access to what is referred to as an income replacement benefit. There are three different ways to qualify for an income replacement benefit. One way is if you were employed and working at the time of the accident. The second option is if you weren't technically working at the time of the accident, but you were employed for 26 out of the 52 weeks before the accident. The third way is if you were, for instance, laid off at the time and were on Employment Insurance (EI); you could still qualify for an income replacement benefit.

The income replacement benefit is far from generous, frankly. It maxes out, unless you purchased optional benefits, at $400 per week. There is a calculation for those who are employed; you will receive up to 70% of your gross income, up to a maximum of $400 a week. Now, that is not a lot, but it is something. For those accident victims who were not working at the time, they can also qualify for what is considered a non-earner benefit.

The non-earner benefit has a waiting period of four weeks. If you continue to be impaired following the four-week period after an accident, you can qualify for this benefit. Although there is a specific legal test attached to this benefit, for which your doctor will have to certify, you can receive up to $185 per week for a non-earner benefit. The maximum period of time for a non-earner benefit is up to two years. In contrast, an income replacement benefit can be paid for your entire life, although the amount you will receive may change on your 65th birthday. After the age of 65, the benefit does change, and more often than not, it is ramped down.

If you qualify for $400, it will be ramped down. The interesting part of an income replacement benefit is that after the first two years of receiving the benefit, the legal test will change. For the first two years, the legal test is whether you are able to do your own job. Whatever you were doing in life is what it's measured against. After two years, the test changes. The legal test then asks the question: Are you able to do any type of job for which you are reasonably suited by means of your education, your experience, your age, etc.?

At the two-year mark, that is often when we see insurance companies deny most claims. They say, "Look, we've paid you for 104 weeks or two years. We accept that you can't do your job, but now we think that you're able to do another job." It may not be as physical; it may be less intense, but they believe there are a variety of jobs that you can do, such as working in a movie theater, being a parking lot attendant, or being a telephone operator. That is when you often see most denials stemming from an income replacement benefit.