Accident Benefits

You are entitled to receive accident benefits from an insurance company, no matter who is at fault.  The insurance system is complicated and our job, as lawyers, is to simply the process for you and lighten your burden.

1. What are accident benefits?
   Every automobile insurance policy contains statutory (mandatory) accident benefits coverage. These accident benefits will cover a wide range of medical and rehabilitation expenses over and above what is paid by OHIP. Regardless of who is at fault for the accident or the seriousness of your injuries, the accident benefits insurer is required to pay for these expenses.
2. Who is required to pay for these expenses?
   If you are injured in an automobile accident, there is always an accident benefit insurer which is one of the following:
   • Your own insurance company;
   • The insurer of the vehicle in which you were a passenger;
   • The insurer of any other vehicle involved in the accident;
   • The Motor Vehicle Accident Claims Fund set up by the Government of Ontario.

   The insurance process is quite complicated and includes very specific time limits that must be met to avoid delay or denial of your benefits. During your initial free consultation (link to Free Consultation form), we will help you fill out the accident benefits application.

3. How and when should I talk to the insurance company?
   When you are claiming accident benefits, you need to notify the accident benefits insurer and provide information in support of your claim. In most cases, your insurance company will send an insurance adjuster to meet with you and talk about the accident and your injuries. Here are some important points to remember:
   • Be aware that anything you say to the insurance adjuster will go into your file and can affect your future accident benefit and tort claims.
   • Only talk to the adjuster when you are medically able.
   • Get legal advice and know your rights before meeting with the adjuster. Why? Insurance companies deal with cases like yours all the time. This is likely your first time dealing with an adjuster. Keep the playing field level by knowing your rights.
   • You have no obligation to speak to an adjuster from the insurance company of the at-fault person. However if you choose to, we recommend that you speak to a lawyer first.
4. How do I complete all of the forms?
   When you are claiming accident benefits there are several forms that must be completed before any benefits are paid. FRASCA KIM Lawyers can help you complete the forms during the initial meeting.
5. Who chooses the case manager or treatment providers?
   The injured person is entitled to select case managers and other treatment providers. We recommend that you interview qualified health care professionals before you make a choice. Lawyers, social workers and insurers can put you in touch with these professionals.
6. What types of benefits are available?
   You may be entitled to receive the following benefits:
   [Note: Your insurance plan may vary in coverage.]
   • Medical & Rehabilitation and Attendant Care Benefits
     The insurer may be required to pay all of the reasonable expenses incurred as a result of your accident, including:
     • medical, hospital and nursing care,
     • chiropractic, psychological and occupational therapy,
     • medication, prescription eyewear, dental devices and medical aids,
     • transportation to and from treatment sessions,
     • social and vocational rehabilitation,
     • family and financial counselling,
     • home renovations and vehicle modifications.

     For accidents occurring on or after June 1, 2016, the maximum benefit available for non-catastrophic impairment claims is $65,000 for medical and rehabilitation and attendant care benefits. If you suffered only a minor injury this benefit is capped at $3,500.
     If your injury is determined to be catastrophic, your coverage increases substantially up to $1,000,000.00 for certain expenses incurred over your entire lifetime.

   • Income Replacement Benefit
     If you are unable to work you may be entitled to up to 70% of your gross weekly income to a maximum of $400 per week.
   • Non-Earner Benefit
     For students, stay at home parents, the unemployed and retirees, you may be entitled to recieve $185 per week, commencing four weeks after the accident, for a maximum of two years if you were seriously injured.
   • Caregiver Benefit
     You may be entitled to a maximum of $250 per week and an additional $50 per week for each person, such as a child or a person who suffers from mental or physical incapacity, in need of care if you were the primary caregiver.
   • Catastrophic Impairment Benefit
     For accidents occurring on or after June 1, 2016 the maximum benefit available to catastrophically impaired persons (which includes paraplegia or quadriplegia, permanent loss of use of both arms or both legs, loss of vision in both eyes, and severe brain injuries) is $1 million.  If the accident occurred before June 1, 2016 you may be entitled to a maximum of $2 million if you were catastrophically injured.
   • Family Member Expenses Benefit
     Following an accident, there are expenses incurred by family members and those living with the injured person who visit during your treatment or recovery. They may be able to recover expenses such as mileage, meals, travel expenses, parking, fares and hotel. Please remember to record and keep your receipts.
   • Death & Funeral Expenses Benefit
     If a family member has died as a result of injuries sustained in the accident, the spouse and dependants are entitled to certain death benefits as well as reimbursement for funeral expenses.