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:
- The payment provided by the benefit
- The test for entitlement to payments
- 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:
- Insurance Act, Ontario Regulation 34/10.
- ‘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.
- ‘Incurred expense’ is a term defined both in the SABS and in case law interpreting the language of the SABS.
- ‘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.
- 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
We understand that being denied disability benefits can be frustrating and devastating. Your time to fight your disability insurance company is limited. Please do not delay in calling long term disability lawyer. We have successfully sued numerous disability insurance companies including: Manulife, Sunlife, Desjardins, Great West Life, Blue Cross, AIG, SSQ, RBC, Industrial Alliance and more.
Call your trusted long term disability lawyers at 1-888-GOKOTAK (Toll Free for all of Canada), or (416) 816-1500 (Local Number for Ontario Residents), (403) 319-0071, (587) 414-1010 (Local Numbers for Alberta Residents). Our consultation is free and we don’t get paid until you do. We can meet you at our offices, at a coffee shop, your home or a local court house. We represent disabled people throughout Ontario and Alberta, including Toronto, Mississauga, Brampton, Milton, Georgetown, Orangeville, Oakville, Burlington, Hamilton, St.Catharines, Niagara Falls, Stoney Creek, Kitchener/Waterloo, Cambridge, London, Windsor, Markham, Pickering, Oshawa, Peterborough, Keswick, Kingston, Ottawa, Banff, Brooks, Calgary, Edmonton, Fort McMurray, Grande Prairie, Jasper, Lake Louise, Lethbridge, Medicine Hat, Red Deer, Saint Albert and other locations.
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.
