Accident benefits are a crucial component of auto insurance in Ontario, providing financial protection and support for individuals injured in motor vehicle accidents, regardless of fault. Here’s an overview of accident benefits in Ontario and what you can claim:
Income Replacement Benefit:
If you’re unable to work due to injuries sustained in an accident, you may be eligible for income replacement benefits. The standard coverage provides 70% of your gross income, up to $400 per week[1][4]. You have the option to increase this limit to $600, $800, or $1,000 per week for additional premium[3].
Medical and Rehabilitation Benefits:
These benefits cover expenses related to your medical treatment and rehabilitation that are not covered by OHIP or private health insurance. For non-catastrophic injuries, the standard coverage provides up to $65,000[4]. This can be increased to $130,000 through optional benefits[4].
Attendant Care Benefits:
If you require personal care assistance due to your injuries, attendant care benefits can help cover these costs. The standard coverage for non-catastrophic injuries is included in the $65,000 limit for medical and rehabilitation benefits[4].
Caregiver Benefits:
If you were the primary caregiver for dependents before the accident and can no longer fulfill this role, caregiver benefits can provide financial assistance. The standard policy offers this benefit only for catastrophic injuries, but you can opt to extend it to cover all injuries[1][4].
Non-Earner Benefits:
If you don’t qualify for income replacement benefits and are a student or unemployed, you may be eligible for non-earner benefits. These provide $185 per week, starting 4 weeks after the accident[4].
Housekeeping and Home Maintenance Expenses:
The standard policy covers these expenses only for catastrophic injuries, but you can opt to include coverage for all injuries[1].
Death and Funeral Benefits:
In the unfortunate event of a fatality, death benefits provide financial support to the deceased’s spouse and dependents. The standard policy offers $25,000 to a spouse and $10,000 to each dependent[1]. Funeral expenses are covered up to $6,000, which can be increased to $8,000 through optional benefits[1].
Catastrophic Injuries:
For catastrophic injuries such as paralysis, loss of limbs, or severe brain injuries, the standard policy provides up to $1 million for medical, rehabilitation, and attendant care benefits combined[4]. This can be increased to $2 million through optional benefits[4].
It’s important to note that there are time limits for claiming these benefits. You must notify your insurer of your intention to claim within 7 days of the accident, or as soon as practicable. The application for benefits must be submitted within 30 days of receiving the application forms from your insurer[5].
To build your accident benefits file, you should:
- Report the accident to your insurance company immediately.
- Keep detailed records of all medical treatments, rehabilitation services, and related expenses.
- Document your injuries and how they affect your daily life and ability to work.
- Retain all receipts for out-of-pocket expenses related to your injuries.
- Keep a log of any caregiving or housekeeping assistance you require.
- Obtain medical reports from your healthcare providers detailing your injuries and prognosis.
It’s also worth noting that you have options to customize your coverage.
If you’re involved in an accident as a passenger, pedestrian, or cyclist, you can still claim accident benefits. In these cases, you would typically claim through the insurer of the vehicle involved in the accident[2].
While the standard accident benefits provide a baseline of coverage, it’s often advisable to consider purchasing additional optional benefits. These can significantly increase your protection, especially in cases of severe injuries that may have long-term impacts on your life and livelihood.
Remember, navigating the accident benefits system can be complex. If you’re unsure about your entitlements or how to proceed with a claim, it’s advisable to consult with an insurance professional or a lawyer specializing in accident benefits. They can help ensure you receive all the benefits you’re entitled to and guide you through the claims process.