Purchasing car insurance is mandatory in Ontario to drive a vehicle, but do you actually know what this insurance covers? We hope you will never need to utilize these benefits; however, it is important to know what exactly you are entitled to in the event of a motor vehicle accident. 

In Ontario, the Statutory Accident benefits Schedule (“SABS”) sets out what is covered under your car insurance policy. Accident benefits are a mandatory part of your policy. Some accident benefits are optional, which you can add-on to your policy, while others are standard and included in every Ontario car insurance policy. 

REMEMBER – in Ontario, you are entitled to accident benefits even if you are deemed at fault for the accident. Following an accident, it is important to take advantage of these benefits to access the care you need. 

The following benefits are standard across all Ontario policies:  

MEDICAL, REHABILITATION AND ATTENDANT CARE BENEFITS 
In the event of an accident, you may be entitled to medical, rehab and attendant care benefits above what your private health plan may cover. Depending on the extent of your injuries, you may qualify for up to $3,500, $65,000 or $1,000,000 in medical benefits. Head to this article for more information on how insurance companies will decide what category you fall into.  

This benefit may cover health care and rehabilitation services such as psychotherapy, counselling and prescriptions not covered by OHIP or your private insurance plan. It is important to remember this money is not provided in a lump sum – it will cover necessary medical services on an as needed basis.

INCOME REPLACEMENT, NON-EARNER AND CAREGIVER BENEFITS
The following three benefits are all available to you under your insurance policy; however, you can only elect to receive one of the three. As you will see, they all relate to your ability to earn an income or provide for yourself or your family. Therefore, you may only receive one of the three benefits. Our lawyers can help you determine which benefit is best suited to your specific situation. 

a) INCOME REPLACEMENT BENEFIT
You may be entitled to income-replacement benefits if you were employed at the time of the accident or employed for at least 26 weeks during the 52 weeks before the accident and suffer a “substantial inability to perform the essential tasks of that employment”. This benefit is meant to compensate you in the event that you can no longer work following the accident. 

You may be entitled to this benefit after the first seven days following your accident. The weekly amount of this benefit is 70% of your gross weekly employment income before the accident, up to $400 for 104 weeks following the accident. The insurer may reduce this amount depending on any other income replacement you are receive (i.e., ODSP government assistance). 

b) NON-EARNER BENEFIT
You may be entitled to the non-earner benefit if you do not qualify for income replacement benefits. To qualify for the non-earner benefit, you must “suffer a complete inability to carry on normal life” because of the accident. For example, if you were enrolled in school at the time of the accident and you are no longer able to carry on your normal life and attend school, you may qualify for this benefit.  

The non-earner benefit entitles you to $185 per week, starting four weeks after the accident, for up to 104 weeks following the accident. 

c) CAREGIVER BENEFIT
If you are determined to be catastrophically impaired, you may be entitled to caregiver benefits. You may be entitled to this benefit if after the accident you are unable to engage in caregiving activities you were performing at the time of the accident. For example, if you were the primary caregiver to a child at the time of the accident, and your injuries are so severe you are unable to take care of your child on your own, you may be entitled to this benefit. This benefit entitles you to $250 per week for the first person in your care, and $50 per week for each additional person in your care. 

As you can see, your insurance policy may provide you with many necessary benefits following an accident, even if you are found at fault for the collision. Your policy may also include other benefits not discussed in this article. While it is important to be aware of your entitlement to these benefits, our team at Pollack Tsimerman is highly knowledgeable in this area of law and can assist with determining your eligibility. If you have any specific questions about insurance coverage following an accident, do not hesitate to contact our office.