May 06, 2021, Kitchener, Ontario
Posted by: Robert Deutschmann, Personal Injury Lawyer
Under Ontario’s no fault auto insurance scheme, injuries resulting from any vehicle accident are categorized and the injuries are clearly defined and the maximum medical benefits. You access the benefits by making an application to your insurer. Sometimes your insurer may take an unreasonable position regarding your injuries and deny benefits. We can represent you if this happens to make sure you get the help you need to recover from your injuries.
Types of Accident Benefits
There are three categories of Personal Injury in Ontario under the no-fault insurance system. While the benefits are among the most generous in Canada, applying for and receiving them can be complicated with many forms to fill out, appointments to attend, and deadlines to keep in mind. This can become overwhelming when you or a loved one are injured, especially if you are off work. Our experienced personal injury lawyers can help you make your claims and get the benefits you need to recover from your injuries.
We can also help you file a tort claim which requires the service of a lawyer.
Minor Injuries: We wrote about those a couple of weeks ago. The Minor Injury classification applies to accident victims (drivers, pedestrians, passengers, cyclists, motorcyclists and more) who have the injuries defined in the Guides (and here). The benefit may not allow you to recover and if you need more medical care you will need the assistance of an experienced personal injury and accident benefits lawyer.
Non-Catastrophic Injury: the Non-CAT injury classification covers those injuries that are in between the ones defined as Minor and those defined as Catastrophic (see below). Injuries in the Non-CAT category include some head injuries, broken bones, soft tissue injuries like muscle tears, damage to ligaments or tendons, and dislocations. The injuries need to be diagnosed and clinically relevant. They will require confirmation by testing. Other damage in the category includes spine or neck injury, and other impairments that are permanent. The aid of a personal injury lawyer is highly recommended in order to navigate the process and ensure all your required benefits are paid.
Catastrophic Injury (CAT Injury) – Catastrophic injuries include the most serious injuries resulting from car accidents. The appropriate diagnosis is required from medical professionals, and an application must be made for the benefits. The physician or neuropsychologist completing the form must have the opinion that the injuries of the claimant meet the strict criteria set out in the Schedule. These injuries include:
- Paraplegia or quadriplegia
- Permanent loss or impairment causing permanent loss of an arm or a leg
- Loss of vision in both eyes
- Severe brain impairment
- Impairment that causes a 55% whole body impairment or marked-extreme impairment due to mental or behavioural disorders.
What Benefits Am I Eligible for?
If you are injured in an accident you may receive the following benefits:
Medical and Rehabilitation benefits:
These are crucial to your recovery from any accident. Your insurer should be paying for the reasonable and necessary medical and rehabilitation expenses which OHIP or your government or private health plan does not pay. Minor Injury maximum benefit is $3500. For non-catastrophic injuries, the maximum claim limit is now $50,000 and you can access the funds for a decade following your accident. In the event of a catastrophic injury the claim limit is $1,000,000 for your lifetime.
You may be able to purchase additional medical benefits which increase your coverage amounts.
Attendant Care Benefits:
ACB are designed to help you if you cannot care for yourself. They will pay for reasonable and necessary expenses relating to a personal care attendant, an aide or a long-term care facility. They are only available for non-catastrophic and catastrophic injuries and have monthly and total maximum limits depending on your claim. They are paid monthly and are up to $3000 or $6000 monthly with limits.
These are paid on a weekly basis to a maximum of $100 a week and are available to Non-Cat and Cat claimants. There are criteria established to qualify for the benefit.
Election of Benefits: In the event of an Accident Benefits claim the injured person can only claim one of the following three benefits. It is important to note that the decision you make here is final. You should seek legal advice before making a decision here.
- Income Replacement Benefits (IRB): The IRB is available to you if you were employed or self-employed at the time of the accident or for 26/52 of the preceding weeks, or if you were on EI benefits. This benefit is payable for up to two years and can be claimed only if you are unable to perform the essential tasks of your job. After two years this will be reassessed based on the criteria and the benefit may either be stopped or if you demonstrate a complete inability to perform any employment for which you are reasonably suited by education, training or experience they may be continued. The maximum of this benefit is $400 a week and is based on 70% of your pre-accident income.
- Caregiver Benefits: If you have been determined to have CAT injuries and you were a caregiver when you were injured in the car accident and you cannot keep doing your caregiver activities then you may be entitled to receive a maximum of $250 per week and $50 additional to cover reasonable costs of care for your first and subsequent obligations.
- Death Benefits: If you die as a result of your injuries your spouse will receive $25,000 and each dependent for whom the deceased was obliged to care for receives $10,000. There is also an additional $25,000 available to divide among remaining dependants.
- Funeral Expenses: These will be paid to a maximum of $6,000
- Incurred Expenses: This is a complex category of expense and you should consult with your Accident Benefits Lawyer.
- Miscellaneous Benefits: These benefits cover the cost of medical assessments, reports, transportation, accounting, and other administrative expenses. They also include the cost of a case manager, lost educational expenses, expenses to your visitors while you are in hospital and compensation for medical devices or clothes damaged in your accident.
Often insurance companies will dispute claims and this is when seeking legal advice becomes crucial.
It is important to seek legal advice at the beginning of your claim if you have been seriously injured as there are decisions you must make which may be irreversible, and timelines that must be met.
You can contact the experienced Personal Injury and Accident Benefit Lawyers at Deutschmann Law online or by phone 1 (866) 414-4878 for your free initial consultation.