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If your car accident occurred on or after September 1, 2010, the following is a brief description of what you may be able to recover both from your own insurance company, and from the insurance company of the at-fault driver.
You are entitled to receive accident benefits from your own insurance company. (If you do not have your own car insurance and you live with a family member that does have insurance, then you must make the application to that policy. If that does not apply then you turn to the driver of the vehicle you were in or as a last resort the other driver’s insurance policy).
Under new legislation which recently came into effect, please note that an Application for Accident Benefits must be filed with your own insurance company within seven (7) days from the date of the motor vehicle accident, or as soon as is practical.
The legislation enables you to receive benefits for loss of income and expenses that are incurred as a result of your accident. The income replacement is 70% of your gross income up to a maximum of $400.00 per week. If you were not working at the time of the accident, you may still be eligible for benefits if your injuries are preventing you from carrying on your regular day-to-day activities.
You are also entitled to receive up to $50,000.00 in medical rehabilitation benefits, as well as reasonable out of pocket expenses that relate to the accident. If your injury falls within the definition of the Minor Injury Guidelines, your medical rehabilitation benefits will be limited to $3,500.00.
Benefits such as caregiving, housekeeping and attendant care are available if your injuries are catastrophic or if your policy has not yet been renewed after September 1, 2010. You should consult with your insurance broker when your policy comes up for renewal in order to decide whether or not you should purchase optional benefits such as attendant care, caregiving and housekeeping for a non-catastrophic injury.
If your car accident occurred on or after June 1, 2016, everything that is listed above still applies, however the following changes have taken effect as of that date. These changes apply to policies that are issued or renewed after June 1, 2016.
First, certain benefits, such as caregiving and housekeeping, are only available if you have purchased these optional benefits on your policy. You should consult with an insurance broker or your insurance company in order to decide whether or not you should purchase any of the optional benefits available to you.
Second, with respect to medical, rehabilitation and attendant are benefits, the duration you are entitled to receive these benefits for non-catastrophic injuries is now 5 years (previously it was 10 years), except in cases involving a minor. For non-catastrophic injuries, there is now a combined limit of $65,000.00 available for medical, rehabilitation benefits and attendant care benefits (previously the limit was $50,000.00 for medical and rehabilitation benefits and $36,000.00 for attendant care benefits). For minor injuries, medical, rehabilitation and attendant care benefits remain fixed at a maximum limit of $3,500.00. Further, for catastrophic injuries, there is now a combined limit of $1,000,000.00 available for medical, rehabilitation and attendant care benefits (previously the limit was $1,000,000.00 for medical and rehabilitation benefits and $1,000,000.00 for attendant care benefits). If you previously purchased optional benefits to increase these amounts, an important thing to remember is that the amounts may have changed as a result of the new legislative changes.
Third, if you were not working at the time of your accident, you may be eligible for a benefit known as the Non-Earner benefit. Previously, there was a six-month waiting period before you would be entitled to receive these benefits. Under the new legislation, the waiting period has been reduced to four weeks. However, under the new legislation Non-Earner benefits can only be received for up to two years after your accident (previously this benefit was potentially available for the rest of your life).
Finally, under the new legislation, for accidents that occur on or after April 1, 2016, the only forum in which to dispute an insurer’s denial of a claim for accident benefits is the Licence Appeal Tribunal (which is part of the Ministry of the Attorney General). Previously, an injured individual who’s insurance company denied a claim for accident benefits had a choice between either pursuing a lawsuit in the Superior Court of Justice, or commencing mediation (and thereafter arbitration) proceedings at the Financial Services Commission of Ontario.
The medical/rehabilitation benefits may cover the following types of expenses:
Higher levels of benefits are available if you have suffered catastrophic injuries.
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