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Involved in an at-fault car accident? You are still entitled to benefits

A person who has been injured in any accident involving a motor vehicle can claim accident benefits regardless of fault. These benefits are available without having to sue a third party. Every automobile insurance policy in Ontario has mandatory accident benefits coverage. These benefits cover not just an occupant of an automobile (eg. cars and buses), but also include pedestrians, cyclists, as well as family members who may also claim benefits if they have suffered losses as a result of your accident.

There are timelines that must be adhered to in order to advance a claim. This includes notifying your insurance company within 7 days of the accident, or as soon as practicable. You must then complete the benefits application package and return them to your insurer within 30 days. If over 30 days have gone by, you may still be able to claim, but you must complete and return the forms as soon as possible.  You should send the forms to your own insurance company, or to another insurance company where you are listed on a policy.  If you do not have insurance and are not on someone else’s policy, the next insurer you should send to would be your spouse’s insurance company, the insurer of the car you were in, or the insurer of any other vehicle involved in the collision, in that order.

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Here are the benefits available:

  • Income replacement benefits cover 70 per cent of your gross income up to a maximum of $400/week.
  • Non-earner benefits are for those who do not qualify for income replacement benefits, a full-time student, or a recent graduate who has not yet secured employment. The claimant needs to have suffered a complete inability to carry on a normal life. This benefit provides a weekly payment of $185 after the initial 26 weeks.
  • Caregiver benefits are for those who served as the primary caregiver for another person, such as a dependent child or an adult in need of care. If eligible, this benefit provides $250/week for the first person and $50/week for each additional person for whom you were the main caregiver.

You may only choose one of income replacement benefits, non-earner benefits or caregiver benefits.

You may also be eligible for the following benefits:

  • Medical benefits cover reasonable and necessary expenses that are not covered by other health plans including OHIP or private health insurance plans.
  • Rehabilitation benefits cover reasonable and necessary expenses to reduce and eliminate the disabilities caused by injuries suffered from the accident, and include counselling and therapy.
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  • Attendant Care benefits are available if you are no longer able to take care of yourself and require assistance with your daily tasks including bathing, grooming and feeding.
  • Lost educational expenses are available if you are unable to complete an educational program as a result of the accident.
  • Housekeeping and home maintenance benefits  are available if you purchased additional housekeeping coverage when you negotiated your auto insurance policy with your broker or agent, unless your injures are deemed to be catastrophic.

If you are unsure of which benefits to select, or if your claim for benefits has been denied, it is best to contact a lawyer who can explain to you how to maximize your claim. Where you have losses not covered by accident benefits and suffered injuries through the liability of another party, you may also sue for economic losses, health care expenses and pain and suffering.