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Overview of Mandatory Statutory Accident Benefits

Posted by Kotak Law Office on July 10, 2015
Posted under Car Accidents, General Information

Overview of Mandatory Statutory Accident Benefits

The following chart contains a summary of the primary Statutory Accident Benefits (accident benefits) that are mandatory in every car insurance policy sold in Ontario. These accident benefits are set out in the Statutory Accident Benefits Schedule1, commonly called the ‘SABS’. There are also ‘optional benefits’ set out in the SABS, and these benefits must be made available for consumers to purchase as a matter of law. Such optional benefits are not addressed below.

Each accident benefits may be understood in three general ways:

  1. The payment provided by the benefit
  2. The test for entitlement to payments
  3. The duration of the benefits

 

 

Name of Benefit

 

 

1) Payment

 

2) Entitlement Test

 

3) Duration

 

Income Replacement Benefit

 

Up to $400 per week

 

 

Within first 2 years after accident: Substantial inability to perform pre-accident employment

 

After 2 year of disability: Complete inability to engage in any employment reasonably suited for by education, training or experience.

 

Reduced at age 65, but payable until death

Non-Earner

Benefit

 

$185 or $320 per week

 

Complete inability to live a normal life’2

Reduced at age 65, but payable until death

 

Care-giver Benefit

 

$250 per week

 

Plus $50 per week for every additional person in need of care

Catastrophic impairment’3 designation required

 

Within first 2 years after accident: Substantial inability to engage in pre-accident caregiving activities

 

After 2 years of disability: ‘Complete inability to live a normal life’

 

Payable as long as there is a person in need of care

 

 

Medical Benefits

 

Incurred expenses’4 for various medical services and devices

 

Up to $3,500 for Minor Injuries

 

Up to $50,000 for Non-minor Injuries

 

Increased to $1,000,000 if insured suffers ‘catastrophic impairment’

 

Reasonable and necessary

Until maximum funding has been paid. 5

 

In most cases medical and rehabilitation benefits are available for 10 years after the accident 

 

But, no time limit when insured suffers ‘catastrophic impairment’

 

 

Rehabilitation Benefit

 

 

‘Incurred expenses’ for the purpose of reducing or eliminating the effects of any disability resulting from the impairment

Up to $3,500 for Minor Injuries

Up to $50,000 for Non-minor Injuries

 

Increased to $1,000,000 if insured suffers ‘catastrophic impairment’

 

 

Reasonable and necessary

 

Attendant Care Benefit

 

‘Incurred expenses’ for aid or attendant services

Up to $3,000 per month to a max of $36,000 total

Up to $6,000 per month to a max of $1,000,000 total if insured suffers ‘catastrophic impairment’

 

Not payable for minor injuries 

Reasonable and necessary

Until maximum funding has been paid.

Available for 2 years after the accident, unless the insured suffers a ‘catastrophic impairment’

 

 

Housekeeping Benefit

 

Incurred expenses’ for housekeeping services

Up to $100 per week

 

Catastrophic impairment’ designation required

Reasonable and necessary

There is no limit on duration or amount

Visitor Expenses Benefit

 

‘Incurred expenses’ of various family members to visit insured

 

Reasonable and necessary

Available for 2 years after the accident, unless the insured suffers a ‘catastrophic impairment’

Education Benefit

 

Lost educational expenses incurred for tuition, books, equipment or room and board

Up to $15,000

 

Unable to continue in enrolled program

Limited to expense incurred before the accident

Damaged Clothing Benefit

‘Incurred expenses’ for:

clothing worn during and damaged as a result of the accident

eyewear, dentures, hearing aids, prostheses and other medical or dental devices

 

Reasonable

Limited to property damaged at time of accident

 

 

Death Benefit

 

To spouse - $25,000

To dependents - $10,000

To former spouse - $10,000

To caregiver of insured - $10,000

 

Insured died as a result of an accident

Generally death must occur within 180 days, but in no case longer than 156 weeks after the accident

One time payment

Funeral Benefit

 

Up to $6,000

Insured died as a result of an accident

 

One time payment

 

Please be aware the SABS are subject to change. The chart above is current as of May 2014. However, the reader should be aware the Ontario Government has introduce a budget to drastically alter these benefits.

To learn more or to discuss your motor vehicle accident, contact your team at Kotak today!

Citations:

  1. Insurance Act, Ontario Regulation 34/10.
  2. ‘Complete inability to live a normal life’ is a term defined both in the SABS and in case law interpreting the language of the SABS.
  3. ‘Incurred expense’ is a term defined both in the SABS and in case law interpreting the language of the SABS.
  4. ‘Catastrophic impairment’ is a term defined both in the SABS and in case law interpreting the language of the SABS. It generally represents very serious injuries.
  5. Both the Medical Benefit and Rehabilitation Benefit ‘incurred expenses’ are combined in calculating whether an insured has reached the $3,500, $50,000, and $1,000,000 limit.

Disclaimer

The contents of this blog are intended to provide general information on the law. It is not intended to form any solicitor-client relationship. Readers are encouraged to seek independent legal advice.  

KOTAK PERSONAL INJURY LAW/DISABILITY LAWYERS CAN HELP YOU
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Disclaimer: This article is intended to supply general information to the public. We make every effort to ensure the accuracy of this information. However, as laws change quickly, the reader should always ensure the accuracy and applicability of such information with respect to their particular case. The information contained in this article cannot replace a thorough and complete review of the reader's situation by competent legal counsel who has had an opportunity to review all of the facts.
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