What type of Injury Benefits can I claim under my Vehicle Insurance?

What type of injury benefits can I apply for under my Vehicle Insurance?

Making a Claim under your Insurance Policy

If you experienced an accident resulting in injuries (whether or not there was property/vehicle damage), then you are eligible to make a claim for accident benefits. These benefits are otherwise known as ‘no fault benefits’ and are available to all Ontarians, regardless who was at fault in the accident.   Statutory accident benefits may be claimed by anyone who was involved in a motor vehicle accident, which includes cyclists, pedestrians and vehicle passengers.  Everyone must claim benefits from their own vehicle insurance provider or from the insurer of a driver involved in the accident.

Your first step is to promptly report the accident and damage to your insurance representative.  This should be done within seven days.  If you wait too long and without good reason, your insurer may not honour your claim. 

If you don’t have insurance coverage but suffered injuries in a motor vehicle accident, then you need to claim under another person’s insurance policy as follows.

• If you were a passenger in the vehicle that was involved in the accident, you can claim on the vehicle owner’s policy.
• If you were a passenger in an uninsured vehicle, you can make a claim against the insurance policy for one of the other driver’s vehicles.
• If you are a pedestrian or cyclist, you can claim on the policy for the vehicle that struck you.
• If none of the people involved in the accident are insured, you can claim under the Ontario Motor Vehicle Accident Claims Fund (MVACF).

Compensation for Injuries under your insurance policy

Statutory accident benefits (SABS) are governed by the Insurance Act of Ontario, and are intended to compensate injured persons for expenses and losses arising from the accident. These benefits are standardized among all insurance companies in Ontario, although vehicle policyholders may opt for additional coverage (which will cover accidents occurring after these extra benefits became effective).

When you apply for injury benefits under SABS, your insurer will provide you with the required auto insurance claim forms including a disability certificate to be completed by a medical professional, detailing the nature and extent of your injuries, as well as an estimate of how long you are likely to be disabled and need treatment.  Your eligibility to receive benefits is dependent on your continuation of prescribed treatment by your health care professional. You are also expected to make a reasonable return to work

The amount of maximum statutory benefits that an injured person is eligible to receive under their insurance policy depends on the classification under which their injuries fall: minor injuries, non-catastrophic injuries or catastrophic injuries. The determination of the severity of your injuries will depend on the medical evidence submitted by your physician(s). 

Standard Accident benefits under SABS include: 

• Income replacement benefits
• Medical, rehabilitation and attendant care expenses
• Non-earner benefits
• Housekeeping and home maintenance expenses
• Death and funeral expenses

Medical, Rehabilitation and Attendant Care Benefits

It is important that you receive treatment from a health professional as your insurance company can deny treatment for ‘non-professional’ therapy.  Included in your potential medical benefits are: medications; medical treatments such as psychological counselling, physiotherapy and chiropractic; wheelchairs, scooters and other devices; modifications to your residence; transportation for medical treatments; and employment re-training and counselling.

Attendant care benefits are available to individuals whose injuries make it difficult or impossible to do personal care activities.  These activities may include, for example, bathing, food preparation, laundry or dressing.  In order to be compensated for this benefit, the person who is providing you aid must have been otherwise employed before having helped you, or be an attendant care worker.  You are advised to check with your insurance representative or consult with a personal injury lawyer if you are unsure whether your caregiver qualifies for this benefit.

Income Replacement

Income replacement benefits are available to someone who was substantially unable to perform the required parts of their job.  The purpose of these benefits is to compensate you for the loss of income experienced due to your injuries from the accident. 

Non-earner Benefits

These benefits are available to someone who is no longer able to function as they did but were not employed, such as a full-time student, prior to the accident.  As with other benefits, the amount to which you are eligible is decreased by the amount you receive from other forms of assistance.

Caregiver benefits

Caregiver benefits are only available to accident victims who have suffered catastrophic injuries.  You are eligible if you were the primary caregiver for another person when the accident occurred, but are now unable to perform that function.

Housekeeping and Home Maintenance

Like caregiver benefits, this benefit is available only to catastrophically injured individuals. 

Miscellaneous Expenses

There are additional expenses for which you may be eligible, including visitor’s expenses incurred by family members who were visiting you while you were injured, and also, lost education expenses.

Death and Funeral Expenses

If someone was fatally injured in an accident, family members may receive up to a maximum amount for funeral costs.   Any dependants and the spouse of the deceased are also eligible for lump sum payments.

Getting the compensation you deserve

It is always a good idea to read your insurance policy over carefully to check your understanding of owed benefits, but that doesn’t always answer all questions or provide certainty that you are getting the benefits you deserve.  Claiming for benefits can be a complicated process. Sometimes the insurance company does not honour a claim for compensation to which you believe you are entitled.  Also, your insurer may stop paying benefits before you or your physician considers yourself to be well again.  In these and many other situations, a knowledgeable Injury Lawyers of Ontario (ILO) attorney can provide strong representation against your insurer so that you get the benefits you are owed.