What Are No-Fault Accident Benefits?

We all know that everyone who drives in Ontario is required to have a policy of automobile insurance.

What many people don’t know, is that every policy of car insurance in Ontario provides mandatory coverage for a number of accident benefits in the event that we are in a collision. This means that your own car insurance policy covers you – regardless of who is at fault.

The same goes for property damage to your vehicle – it is claimed through your own insurance policy.

So, what about if you are in an accident as a passenger and don’t have your own insurance?

Or, if you are a pedestrian or cyclist?

In these circumstances you are still eligible for accident benefits – usually from the policy associated with the vehicle you are in or that hit you.

The no-fault accident benefits system in Ontario was designed to simplify the claims process, and make it easier for injured people to access certain benefits by making them accessible from their own insurer.

The main types of accident benefits available are medical and rehabilitation benefits, which provide coverage for things like treatment expenses such as physiotherapy, counselling, and medications.

AMOUNT OF BENEFITS

The amount available to you for accident benefits varies significantly depending on the nature of your injuries.

For what are called “minor injuries” - usually sprains or strains – the medical and rehabilitation limits are very low, only $3,500.

The next level of coverage is for non-catastrophic injuries – injuries that are more serious than a sprain or strain. For example, a fracture or a concussion.

The limits for medical and rehabilitation benefits for these injuries are $65,000.

The most severe category is called catastrophic injuries, which include for example: serious brain injuries, paralysis and loss of limbs.

The limits for medical and rehabilitation benefits are $1,000,000 for these injuries.

You also have access to attendant care benefits. This means that if you are unable to complete your activities of daily living, such as grooming, dressing, and feeding, you can get funding for assistance from a personal support worker or nurse. The limit for these benefits is combined with medical and rehabilitation benefits. That is, there is a combined total coverage of $65,000 for medical and rehabilitation and attendant care benefits for non-catastrophic injuries.

Another benefit I want to discuss is income replacement. If you were employed at the time of the accident and are unable to work due to your injuries, you may qualify for income replacement benefits of 70% of your gross income up to a maximum of $400 per week. You may also qualify for income replacement benefits if you were self-employed.

If you do not qualify for income replacement benefits, and are unable to carry on the normal life that you led pre-accident, you may be entitled to non-earner benefits in the amount of $185 per week.

ADDITIONAL BENEFITS

There are additional benefits available for catastrophic injuries or when optional coverage is purchased.

These include housekeeping benefits to pay for help around the house and caregiver benefits. If you were the primary caregiver for family members, these benefits reimburse you for the cost of hiring someone to help you with those duties.

So, how do you access all of these accident benefits that may be available to you?

Well, that can be the tricky part. There are very specific rules and procedures that must be followed, and insurers will always try to limit what is available to you and how much they will pay.

Hiring a personal injury lawyer to help you navigate the process and fight with your insurance company on your behalf to get you the highest level of benefits, will allow you to focus on what is most important - your recovery.

Our video series is designed to shed some light on personal injury and disability law and provide the insights you need to make an informed decision about what is best for you and your loved ones.

Be sure to watch the other videos in our Personal Injury Explained series.

We all know that everyone who drives in Ontario is required to have a policy of automobile insurance.

What many people don’t know, is that every policy of car insurance in Ontario provides mandatory coverage for a number of accident benefits in the event that we are in a collision. This means that your own car insurance policy covers you – regardless of who is at fault.

The same goes for property damage to your vehicle – it is claimed through your own insurance policy.

So, what about if you are in an accident as a passenger and don’t have your own insurance?

Or, if you are a pedestrian or cyclist?

In these circumstances you are still eligible for accident benefits – usually from the policy associated with the vehicle you are in or that hit you.

The no-fault accident benefits system in Ontario was designed to simplify the claims process, and make it easier for injured people to access certain benefits by making them accessible from their own insurer.

The main types of accident benefits available are medical and rehabilitation benefits, which provide coverage for things like treatment expenses such as physiotherapy, counselling, and medications.

AMOUNT OF BENEFITS

The amount available to you for accident benefits varies significantly depending on the nature of your injuries.

For what are called “minor injuries” - usually sprains or strains – the medical and rehabilitation limits are very low, only $3,500.

The next level of coverage is for non-catastrophic injuries – injuries that are more serious than a sprain or strain. For example, a fracture or a concussion.

The limits for medical and rehabilitation benefits for these injuries are $65,000.

The most severe category is called catastrophic injuries, which include for example: serious brain injuries, paralysis and loss of limbs.

The limits for medical and rehabilitation benefits are $1,000,000 for these injuries.

You also have access to attendant care benefits. This means that if you are unable to complete your activities of daily living, such as grooming, dressing, and feeding, you can get funding for assistance from a personal support worker or nurse. The limit for these benefits is combined with medical and rehabilitation benefits. That is, there is a combined total coverage of $65,000 for medical and rehabilitation and attendant care benefits for non-catastrophic injuries.

Another benefit I want to discuss is income replacement. If you were employed at the time of the accident and are unable to work due to your injuries, you may qualify for income replacement benefits of 70% of your gross income up to a maximum of $400 per week. You may also qualify for income replacement benefits if you were self-employed.

If you do not qualify for income replacement benefits, and are unable to carry on the normal life that you led pre-accident, you may be entitled to non-earner benefits in the amount of $185 per week.

ADDITIONAL BENEFITS

There are additional benefits available for catastrophic injuries or when optional coverage is purchased.

These include housekeeping benefits to pay for help around the house and caregiver benefits. If you were the primary caregiver for family members, these benefits reimburse you for the cost of hiring someone to help you with those duties.

So, how do you access all of these accident benefits that may be available to you?

Well, that can be the tricky part. There are very specific rules and procedures that must be followed, and insurers will always try to limit what is available to you and how much they will pay.

Hiring a personal injury lawyer to help you navigate the process and fight with your insurance company on your behalf to get you the highest level of benefits, will allow you to focus on what is most important - your recovery.

Our video series is designed to shed some light on personal injury and disability law and provide the insights you need to make an informed decision about what is best for you and your loved ones.

Be sure to watch the other videos in our Personal Injury Explained series.