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Replace Income Lost from Personal Injury

Can I Replace My Income When Injured?

Suffering injuries in an accident can result in having to take time off of work to recover and to focus on rehabilitation and treatment. Many people are fearful of taking the time needed to recover because of the impact it will have on their income. There are several benefits that may be available to an injured person to partially replace their income when they are on a medical leave of absence.

Government Assistance

Employment Insurance (EI) Sickness Benefits. Employment Insurance (EI) sickness benefits can provide an injured worker with up to 15 weeks of financial assistance if they cannot work for medical reasons. The benefit provides up to 55% of lost earnings, up to a maximum of $573 a week.

In order to qualify, a medical certificate documenting that a person is unable to work for medical reasons must be provided. The claimant’s regular weekly earnings from work must have decreased by more than 40% for at least one week, and they must have accumulated 600 insured hours of work in the 52 weeks before the start of their claim (or since the start of their last claim, whichever is shorter).

Ontario Disability Support Plan (ODSP) Benefits. The Ontario Disability Support Plan (ODSP) Benefits offer income support for people who are suffering a disability. A recipient of ODSP can receive up to $1,169 a month for basic needs and shelter. The amount paid will depend on the claimant’s specific situation, taking into consideration family size, housing expenses and medical costs. ODSP also provides health benefits and employment support.

In order to receive ODSP benefits, the injured person must be at least 16 years old, live in Ontario and allowed to work in Canada, and have a physical or mental disability that is expected to last a year or more, and makes it hard for them to find or keep a job. Once it is determined that a claimant is financially eligible for ODSP, a disability determination package is provided for completion by the injured person’s doctor or other health care provider.

Canada Pension Plan (CPP) Disability Benefits. Canada Pension Plan (CPP) Disability Benefits are available to people whose injuries prevent them from returning to work for an extended period of time, or indefinitely. Currently, the basic CPP Disability Benefit is $505.79, which is then increased based on the amount the injured person paid into the CPP while they worked. The maximum monthly payment amount in 2020 was $1,387.66. Dependent children may also be able to receive a monthly benefit.

To be eligible for the CPP Disability Benefit, the injured person must meet the following criteria: be under the age of 65; made sufficient contributions to CPP; have a mental or physical disability that regularly stops them from doing any type of substantially gainful work (i.e. a severe disability); and have a disability that is long-term and of indefinite duration, or is likely to result in death (i.e. a prolonged disability). A medical report is to be completed by the injured person’s doctor or nurse practitioner.

Workplace Safety Insurance Board Benefits. These benefits are only available to people who have been injured in the course of their employment. The WSIB Benefit for loss of earnings pays 85% of the claimant’s take-home pay up to an annual maximum (which in 2020 was $95,400). The WSIB provides a number of benefits to injured workers, if eligible: benefit for non-economic loss; health-care benefits; help to return to work; benefit for loss of retirement income; services for seriously injured people; and services for people with occupational diseases.

An injured worker may be eligible for WSIB Benefits if their employer is covered by WSIB, they have a work-related injury or illness, and the injury or illness was reported to the WSIB by either the worker or their employer. The worker will be required to periodically provide information about their functional abilities to the WSIB and their employer.

Private Insurance Benefits

Income Replacement Benefit (IRB). The Income Replacement Benefit (IRB) is available to people who have been injured in a motor vehicle accident. The IRB is payable after the first week of absence from a person’s employment. The IRB provides payment of 70% of a person’s gross pre-accident income, up to a maximum of $400.00 per week (unless optional benefits were purchased).

In order to be eligible for the IRB, the injured person must suffer a substantial inability to perform the essential tasks of his or her employment or self-employment. To meet this test, the injured person must be substantially prevented from engaging in their pre-accident employment tasks. After 104 weeks, the test for eligibility for the IRB changes. The injured person must show that they suffer a substantial inability to engage in any employment for which he or she is reasonably suited by education, training or experience. An accident benefits application and disability certificate need to be completed and submitted to your own auto insurer in order to receive an IRB. If you (or the person on whom you are dependent) do not have auto insurance, you can apply for accident benefits and the IRB from the insurer of the vehicle in which you were a passenger, or which struck you.

Non-Earner Benefit (NEB). While not technically a form of income replacement, the Non-Earner Benefit (NEB) is available to full-time students, stay at home parents, and unemployed and retired people. The NEB pays a weekly benefit of $185, commencing 4 weeks after the accident. The NEB is payable for a period of two years. A person must be at least 18 years old at the time of the accident to be eligible to receive the NEB.

In order to receive a NEB, the injured person must show that they suffer a complete inability to carry on a normal life within 104 weeks of the date of the accident. To determine if that test is met, a comparison is made of a person’s ability to perform their regular activities before and after the accident. An accident benefits application and disability certificate need to be completed and submitted to your own auto insurer in order to receive an NEB. If you (or the person on whom you are dependent) do not have auto insurance, you can apply for accident benefits and the NEB from the insurer of the vehicle in which you were a passenger, or which struck you.

Short-Term Disability (STD) and Long-Term Disability (LTD) Benefits. Short-Term Disability (STD) and Long-Term Disability (LTD) Benefits are sometimes available as an employment benefit. If available, they will be set out in the employee benefit handbook. Each policy has its own definition of disability that needs to be met to be eligible to receive the STD and LTD benefits. As well, the amount of the STD and LTD benefits will depend on the specific policy obtained by the employer. Typically, an injured person will be paid the STD benefit for a period of time (the elimination period), and then become eligible to apply for the LTD benefit.

The standard requirements are that a person be unable to perform the essential tasks of their employment in order to receive these disability benefits. After a certain period, usually two years, that eligibility requirement changes, and the person must not be able to perform the essential tasks of any employment for which they are reasonably suited by training, education or experience. However, the specific eligibility tests are set out in the applicable policy.

Alysia Christiaen

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