injured in an accident

So You’ve Been Injured in a Car Accident – Who Covers What?

If you are a resident of Ontario and you’ve suffered a personal injury in a car accident, most – if not all – of your medical expenses are covered. However, they are not all covered by the same sources – instead, there is a number of services, from public to private insurance, providing your health coverage, and it can be very important to know in advance who covers what.

The initial provider of your health coverage is public health insurance, known as the Ontario Health Insurance Plan (OHIP). OHIP covers your medical care in the hospital, from surgical procedures to drugs to meals, with a couple of exceptions – a private room, or additional services such as cable television, are out-of-pocket expenses.

Once you have left the hospital, OHIP still covers a number of your expenses. Follow-up appointments with hospital clinics, family doctors, and specialists are covered by OHIP. However, OHIP does not cover everything.

One of the key expenses not covered by OHIP is medication outside of the hospital. This is usually covered by private insurance, sometimes offered through a union, employer, or school, and sometimes acquired by the individual. If you don’t have access to such a plan, there is a provincial government insurance provider covering prescription medication, the Trillium Drug Program . Trillium uses a deductible based on your income tax filing. The more you make, the greater your deductible. While Trillium covers most prescription medications, it does not cover all of them, and you may need to verify that your prescription is covered.

Many of your out-of-hospital extra expenses, however, may be covered by your auto insurance under statutory accidents benefit coverage. While OHIP will provide some coverage for physiotherapy, this is limited to those below the age of 19, above the age of 65, recipients of social services, and those who have been an in-patient overnight at a hospital for their injuries – and even here it is for a limited term (although with a doctor’s referral, it can be extended). If you do not fall under these categories, or your referral has run out, your additional therapy and recovery costs may be covered by the statutory accident benefits in your auto insurance.

Your auto insurance may also provide coverage for additional expenses outside of physiotherapy. In the case of a serious injury, you may need attendant care – this may be reimbursed by the statutory accident benefits, along with coverage for loss of income. If you are a caregiver, the statutory benefits may provide for the costs to bring in a replacement until such time as you are able to resume your former duties.

What if you were struck while on foot by an uninsured driver or became the victim of a hit-and-run? There may be coverage available from Ontario’s insurance payer of last resort, the Motor Vehicle Accident Claims Fund (MVACF).

When you have suffered an injury in an auto accident, it is just as important to know who covers what part of your treatment and rehabilitation, as it is to know that they are covered. While coverage through OHIP is more or less automatic, coverage through the statutory accident benefits or the MVACF requires you to apply for them. Failure to do this quickly enough can result in being denied the coverage you need. Knowing what is covered and by whom is one less worry allowing you to move on with therapy and recovery.

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