| 1. I was injured in a car accident. Am I entitled to | | | | or, if the deceased was continuously disabled as a |
| compensation? | | | | result of the accident, within 156 weeks after the |
| In addition to the possibility of a lawsuit to | | | | accident. No benefits will be payable to a person |
| recover a money award or settlement for | | | | who dies before the deceased or within 30 days |
| injuries, pain and suffering and other losses, | | | | after the deceased. |
| Ontario's government requires automobile insurers | | | | A spouse may receive $25,000 if the deceased |
| to provide certain mandatory benefits to most | | | | was married. If the deceased was not married, |
| people who are injured or killed in car accidents. | | | | but had dependents, the $25,000 would be divided |
| These benefits are called "statutory accident | | | | equally among the dependents. On top of the |
| benefits". The statutory accident benefits system | | | | $25,000, each of the dependents and former |
| operates on a "no-fault" basis. This means that, | | | | spouses of the deceased (to whom the deceased |
| subject to some limited restrictions, you may be | | | | had an obligation to pay spousal support) will be |
| entitled to compensation even if you are the one | | | | entitled to $10,000. |
| that caused the accident. | | | | If the deceased was himself or herself a |
| As an injured party, you may well be entitled to | | | | dependent at the time of the accident (ex. if the |
| receive benefits regardless of whether you were | | | | deceased was a minor child), $10,000 would be |
| a driver, passenger, cyclist or pedestrian. You, as | | | | payable to the person upon whom the deceased |
| well as your family members and dependants, can | | | | was dependent (ex. parent or grandparent) or, if |
| often receive benefits even if you did not have | | | | that person is dead, to that person's surviving |
| car insurance at the time of the accident. | | | | spouse or dependents. |
| There are often disputes about what benefits | | | | Visiting Expenses - if you sustained injury in a car |
| you are entitled to and what insurance | | | | accident, your family members and individuals who |
| assessments you are required to attend. It is | | | | were living with you at the time of the accident |
| often a good idea to consult with a personal injury | | | | may be entitled to reimbursement for all of their |
| lawyer to determine what you are entitled to and | | | | reasonable and necessary expenses incurred as a |
| what steps you need to take to protect your | | | | result of coming to visit you during your |
| interests. | | | | treatment or recovery. The visitors will only be |
| 2. What kind of benefits can I receive? | | | | reimbursed for expenses incurred within 104 |
| Income Replacement Benefits - these benefits | | | | weeks after your accident, unless your injury is |
| are designed to reimburse you for some of the | | | | catastrophic. |
| money you lose as a result of being unable to | | | | Lost Education Expenses - if, due to your injuries, |
| work due to an injury suffered in a car accident. | | | | you are unable to continue in the education |
| Benefits are not payable for the first week and | | | | program in which you were enrolled at the time |
| you must meet a disability test to qualify for the | | | | of the accident, you may be entitled to claim for |
| benefits. The disability test becomes more difficult | | | | your lost education expenses up to the maximum |
| to meet after more than two years have passed | | | | amount of $15,000. You may get reimbursed for |
| since the accident. | | | | expenses incurred before the accident including |
| You can receive income replacement benefits | | | | tuition, books, equipment or room and board. |
| whether you are an employee or a self-employed | | | | Housekeeping and Home Maintenance Expenses - |
| individual. The maximum that you can receive is | | | | you may receive compensation for reasonable |
| generally $400 per week, unless other optional | | | | and necessary housekeeping and home |
| increased benefits are purchased. | | | | maintenance expenses, if your injury resulted in a |
| If you are self-employed, your income calculation | | | | substantial inability to do your housekeeping and |
| will be more complicated and insurers often hire | | | | home maintenance and you normally performed |
| accountants to assist them with these calculations. | | | | home maintenance services before your accident. |
| Non-earner Benefits - you may receive these | | | | Your housekeeping and home maintenance |
| benefits if you are 16 years of age or older and | | | | expenses may be paid for 104 weeks to a |
| have suffered a complete inability to carry on a | | | | maximum of $100, unless the injury is |
| normal life as a result of the accident within 104 | | | | catastrophic, in which case the time-limit does not |
| weeks after the accident. A lawyer can assist in | | | | apply. |
| explaining what "complete inability to carry on a | | | | Psychological and Mental Injuries - your family |
| normal life" means and how that term has been | | | | members and dependents (whether related or |
| interpreted by the cases. The benefits are only | | | | not) may be entitled to receive benefits if they |
| available to certain classes of people, ie: | | | | have suffered psychological injuries as a result of |
| unemployed but enrolled in school on a full-time | | | | your accident. |
| basis, or have completed your education less than | | | | Cost of Examinations - you may be reimbursed |
| one year before the accident and not be | | | | for reasonable fees charged by health care |
| employed in a job that reflects your education | | | | providers in preparing disability certificates, |
| and training. | | | | reviewing and approving treatment plans, |
| The amount of the non-earner benefit is generally | | | | preparing applications for approval of assessments |
| $185 per week, although nothing will be payable | | | | or examinations, preparing assessments of |
| for the first 26 weeks of the disability. However, | | | | attendant care needs, and preparing applications |
| if your disability has lasted for more than 104 | | | | for determinations of catastrophic impairment. |
| weeks, you will be entitled to receive $320 per | | | | You are normally required to obtain consent of |
| week following the initial 104 week period. | | | | the insurer before incurring examination expenses. |
| Caregiver Benefits - these benefits may be | | | | However, there are certain exceptions. Your |
| payable if you (the injured person) were living | | | | treatment providers may well be able to assist |
| with a person in need of care (such as a young | | | | you in applying for these benefits |
| child or an elderly parent) prior to the accident and | | | | Other Expenses - you may be entitled to be |
| were not being paid for these services. You may | | | | reimbursed for all reasonable expenses you |
| be able to recover reasonable and necessary | | | | incurred in repairing or replacing clothing, |
| expenses up to a maximum of $250 per week | | | | prescription eye wear, dentures, hearing aids, |
| for the first person in need of care and $50 per | | | | prostheses and other medical or dental devices |
| week for each additional person. You should note | | | | that were lost or damaged as a result of the |
| that when it comes to the income replacement, | | | | accident. |
| non-earner and caregiver benefits, only one of | | | | 3. How can I claim my benefits? |
| these three benefits can be paid at any given | | | | Compensation will not be paid to you automatically |
| period of time. | | | | following your accident. In order to receive |
| Medical and Rehabilitation Benefits - this benefit | | | | benefits, you should notify your insurer within |
| deals with reimbursement for reasonable and | | | | seven days of the date of the accident that you |
| necessary expenses such as medical, surgical, | | | | wish to submit an application. Late applications are |
| dental, optometric, hospital, nursing, ambulance, | | | | made in many cases and you could discuss this |
| audio metric, speech-language pathology, | | | | with a lawyer. The insurer will then be required to |
| chiropractic, psychological, occupational therapy, | | | | send you the application forms as soon as |
| physiotherapy, medication, prescription eyewear, | | | | possible. You will have to complete the forms and |
| dentures, hearing aids, wheelchairs, prostheses, | | | | send them back to your insurer within 30 days. If |
| orthotics, transportation to and from treatment | | | | you will not be able to meet the 30-day deadline |
| sessions (excluding the first 50 kilometers of the | | | | because of the severity of your injuries, it is |
| trip in the injured person's vehicle), workplace | | | | probably a good idea for you to advise your |
| home/vehicle modifications, life skills training, | | | | insurance company (but you may well wish to |
| counseling, and vocational assessments. | | | | seek legal advice from a lawyer). |
| Subject to some exceptions set out in the | | | | 4. Which insurance company will provide my |
| pre-approved framework guidelines, you must | | | | statutory accident benefits? |
| submit a treatment plan to the insurance | | | | If you have car insurance or if you are a listed |
| company prior to beginning treatment. If you do | | | | driver on someone else's auto insurance policy, |
| not submit a treatment plan, the insurance | | | | your own insurer will likely be responsible for |
| company could refuse to compensate you for | | | | providing you with benefits. |
| treatment. The treatment plan must be prepared | | | | If you do not have auto insurance, and you were |
| by a health professional and signed by one of the | | | | injured in a car accident as a pedestrian or a |
| following - physician, psychologist, physiotherapist, | | | | cyclist, you may be able to apply to the insurance |
| dentist, or optometrist. | | | | company that insured the car that hit you. If you |
| You can receive a maximum reimbursement of | | | | were a passenger, you may well be able to apply |
| $100,000 for "reasonable and necessary" | | | | to the company that insured the car in which you |
| expenses acquired in the period of 10 years | | | | were riding. |
| following the accident. If you suffered | | | | In some situations, no insured drivers are involved. |
| "catastrophic impairment", you may be entitled to | | | | In such cases, you may be able to claim |
| receive up to $1,000,000 incurred over your | | | | compensation from a special government fund |
| lifetime. | | | | (the "Motor Vehicle Accident Claims Fund") set up |
| Attendant Care Benefits - this benefit may | | | | to handle these type of scenarios. |
| provide compensation for services of an aide or | | | | It is important to remember that statutory |
| an attendant who is assisting you due to your | | | | accident benefits will generally only compensate |
| injury. This could include services of a family | | | | you for losses that are not covered by some |
| member or other aide looking after you at home, | | | | other private insurance policy or employment |
| or services provided by a long-term care facility | | | | benefits plan. If these other policies or plans will |
| including a nursing home, home for the aged or | | | | cover only part of the losses incurred, the |
| chronic care hospital. | | | | statutory accident benefits can be used to |
| You may be entitled to a maximum of $3,000 | | | | compensate you for the balance, subject to |
| per month for two years following the accident. If | | | | some limitations. |
| you suffered "catastrophic impairment", you may | | | | 5. What can I do if the insurance company denied |
| receive up to $6,000 per month up to a | | | | my claim for benefits? |
| maximum of $1,000,000 without a time limit. The | | | | If you are having problems recovering benefits to |
| insurer may ask you to provide it with a | | | | which you are entitled, you may be entitled to |
| certificate from a health professional confirming | | | | sue the insurer in court or try to enforce |
| that you require attendant care services. | | | | payment through arbitration. However, before |
| Funeral and Death Benefits - when a person dies | | | | you can proceed to court or to arbitration, you |
| due to a car accident, his or her estate may be | | | | are required to mediate the dispute with the |
| entitled to reimbursement of funeral expenses to | | | | Financial Services Commission. It is extremely |
| a maximum of $6,000. | | | | important to initiate mediation within two years |
| The deceased's spouse, dependants and | | | | from the date that the benefit was denied. An |
| caregivers may also be entitled to death benefits. | | | | injury/car accident lawyer can provide further |
| Death benefits are usually only payable if the | | | | details with respect to this. |
| deceased died within 180 days after the accident, | | | | |