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 the outline 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 1st, 2016, there will be amendments to the maximum allowable benefits for injured persons.
Medical, Rehabilitation and Attendant Care Benefit
Injuries arising from a motor vehicle accident are characterized as minor, non-minor or a catastrophic impairment, with respect to the amount of eligible benefits under your Ontario motor vehicle insurance policy.
The most significant change in SABS benefits impacts the amount of medical, rehabilitation and attendant care funds available to a catastrophically injured accident victim. Up to June 1st, 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 1st, when the combined medical, rehabilitation and attendant care benefit becomes a maximum of $1 million in total.
After June 1st, the maximum benefit for non-minor injuries, 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 was available before June 1st. 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.
Effective June 1st, the duration for which the non-earner benefit may be claimed is changing to two years following the accident, and claimants must wait four weeks before receiving this benefit. Only insured persons 18 years or older are eligible.
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 1st 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.
The legal guidelines for defining a catastrophic impairment have been revised to reflect 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 1st. 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 injured in a motor vehicle accident or are being denied benefits by your insurer, contact the experienced personal injury attorneys at Kotak Law. 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.