QUESTION 1: I was in a car accident. Who Pays my Medical Expenses?
Ontario has a partial no fault car insurance system. That means that there are certain benefits that are paid to an injured person regardless of whether or not you were at fault in the accident, subject to some narrow exceptions.
These benefits are called Statutory Accident Benefits. They are also called, SABS, ABs or no-fault benefits.
These benefits include some medical expenses that you may face that are not covered by OHIP. The funding available depends on how serious your injuries are.
There are three levels of medical / rehabilitation benefits: $3500, $50,000 and $1Million. Some people purchase optional increased benefits as well.
QUESTION 2: What Benefits Are Available?
Some of the compensation you can claim as Statutory Accident Benefits include:
- Income Replacement Benefit — compensates for lost wages up to a ceiling
- Caregiver Benefit — compensates where the injured person was the caregiver for a family member
- Non-earner Benefit — compensates people who cannot carry on normal life but who do not qualify for income replacement or caregiver benefits
- Medical Benefit — compensates for medical expenses
- Rehabilitation Benefit — compensates for rehabilitation expenses
- Attendant Care Benefit — compensates you for expenses when you need a caregiver
You can also recover benefits for items damaged in the accident, such as glasses or clothing. Also, in some cases you can recover benefits for housekeeping, home maintenance, lost educational expenses and family visits. Note: not everyone has all of the coverage above. Check with your insurance agent to see what optional benefits you purchased.
QUESTION 3: Do I Automatically Qualify for the Benefits?
The benefits are not automatic. You have to apply for them, using a system of forms that will be provided to you by the responsible insurance company upon request. Some of the benefits require your doctor or other health care provider to complete a certificate indicating that you need the services.
A lawyer or a law clerk can assist you with the forms if you find them difficult to complete.
QUESTION 4: What Insurance Company is Responsible for My Benefits?
If you have auto insurance, or are a listed driver on someone’s auto insurance, your own insurance company will answer your claim for Statutory Accident Benefits.
If you do not have your own auto insurance, you will still be entitled to Statutory Accident Benefits. There are rules for virtually every situation. For example, if you were a pedestrian or a cyclist, your Statutory Accident Benefits will be paid by the company that ensures the car that hit you. If you were a passenger, the Benefits will be paid by the company that insures the car you were riding in.
In situations where there is no insured driver involved in the accident, there is a special fund available to provide benefits.
For more information about obtaining your Statutory Accident Benefits, contact Richard Auger or Brenda Hollingsworth by calling 613 233-4529 or using our online Contact Form