Changes to Statutory Accident Benefits effective June 1st 2016

Anyone in Ontario who is injured in a motor vehicle accident may file for statutory accident benefits under their vehicle insurance policy or under the policy of the driver involved in the collision. This provision is available whether you are a driver, passenger, pedestrian, cyclist or ATV rider, and applies equally to accident victims as it does to the person who was responsible for causing the accident.  For this reason, Ontario statutory accident benefits are commonly termed ‘no fault’ insurance.

The regulations that mandate the types of benefits and conditions for receiving statutory accident benefits (SABS) fall under Ontario’s Insurance Act.  For vehicle insurance policies renewed or issued after June 1^st, 2016, there will be amendments to the maximum allowable benefits for injured persons in Ontario. 

Medical, Rehabilitation and Attendant Care Benefit

The most significant change in accident benefits pertains to the amount of medical, rehabilitation and attendant care funds available to a catastrophically injured accident victim.  Until June 1^st, a person who sustained a catastrophic impairment was eligible to receive up to $1 million in medical and rehabilitation benefit, as well as up to $1 million for attendant care.  However, these benefits are effectively cut in half after June 1^st, when the combined medical, rehabilitation and attendant care benefit becomes a maximum of $1 million in total. 

After June 1^st, the ‘standard’ maximum benefit for combined medical, rehabilitation and attendant care is $65,000, which is also a reduction from the previous amounts of $50,000 plus $36,000 (for a total of $91,000) that were available before June 1^st.  Note that ‘standard’ benefits are available to accident victims whose injuries are deemed to be greater than a ‘minor’ injury but not as severe as a ‘catastrophic impairment’, according to the guidelines under SABS.

Another change is to the duration period under which benefits may be claimed.  The new duration for ‘standard’ injury claims is five-years (which replaces the previous 10 year duration limit for medical/rehabilitation benefits).  This five year duration period does not apply to children under 18 or to accident victims who suffered a catastrophic impairment.

Non-earner Benefit

Effective June 1^st, the duration for which the non-earner benefit may be claimed is changing to two years following an accident, and claimants must wait four weeks before receiving this benefit.  Only insured persons 18 years or older are eligible.

Optional Benefits

Policyholders may purchase an optional benefit for catastrophic impairment to pay up to $1 million for medical, rehabilitation and attendant care expenses (which essentially provides the same level of benefit as was available prior to June 1^st but at a higher cost to Ontario vehicle owners).  A new optional combined benefit of $130,000 will be available, in addition to the existing optional $1 million in combined medical, rehabilitation and attendant care benefit, which replaces the previous optional benefits of $100,000 for medical/rehabilitation and $72,000 for attendant care.

Catastrophic Impairment

The legal guidelines for defining a catastrophic impairment have been revised to reflect more up-to-date information.  This includes new criteria for classifying traumatic brain injuries, amputations, loss of eyesight, and mental and behavioural impairments.   Under the new guidelines, catastrophic impairment for children who sustained traumatic brain injury will become automatic under specified circumstances.

Claiming Statutory Accident Benefits

The process for filing a claim for statutory accident benefits is essentially unchanged, however, the maximum amount of benefit available to seriously injured Ontarians will be substantially reduced effective June 1^st.   This change will result in a higher financial burden for Ontario vehicle owners, many of whom will give consideration to paying for optional benefits rather than being at a higher risk in the event of an accident resulting in serious injury.   Critics suggest that these changes to SABS are yet another ploy to divert more money into the hands of insurance companies with the alleged objective of reducing insurance premiums.  Whether or not the reduced premiums become a reality remains to be seen, but certainly, such changes make recovery more difficult for seriously and catastrophically injured accident victims who in some cases, will not have the financial means to advance an optimal recovery.

If you were seriously injured in a motor vehicle accident or are being denied benefits by your insurer, contact the experienced personal injury attorneys at Injury Lawyers of Ontario (ILO).  In a no-obligation consultation, we can learn the facts of your case and offer frank advice on your legal rights and various options for obtaining owed injury compensation.