As an Ontario personal injury lawyer in Ottawa, I am concerned about the upcoming changes to accident benefits and those who suffer a personal injury due to an accident.  I fear many Ontario accident victims will be left under insured and left to “fend for themselves” with their personal injury. While  supplemental insurance will be availabe, the questions are who can afford it? Who will buy it?

Changes and Ontario personal injury..

Wrongful Death Deductible and Ontario personal injury…

·         $15,000 deductible- death of a loved one will be eliminated.

General Damages Awards and Ontario personal injury…

·         $30,000 deductible for pain and suffering awards may be reduced to $20,000, but only if the insured person purchases the optional coverage.

Family Law Act Damage Awards and Ontario personal injury…

·         $15,000 deductible for the loss of care, guidance and companionship awards (FLA) may be reduced to $10,000 if the insured person purchases the optional coverage.

Changes to Accident Benefits

“Minor Injuries” Cap Established

Claimants who sustain an impairment that is “predominantly a minor injury” will have access to  reduced medical and rehabilitation benefits up to $3,500,  including assessment costs, and are no  longer entitled to attendant care benefits or housekeeping or caregiver benefits.  The $3,500 cap will not apply to a person if their health care practitioner determines and “provides compelling evidence” that the insured person has a pre-existing medical condition that will prevent them achieving maximal recovery from the minor injury. 

What is a minor personal injury?

“minor injury” can be a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae;

“sprain” means an injury to one or more tendons or ligaments or to one or more of each, including a partial but not a complete tear;

“strain” means an injury to one or more muscles, including a partial but not a complete tear;

“subluxation” means a partial but not a complete dislocation of a joint;

“whiplash associated disorder” means a whiplash injury that,

- does not exhibit objective, demonstrable, definable and clinically relevant neurological signs, and

- does not exhibit a fracture in or dislocation of the spine;

Medical and Rehabilitation Benefits and Ontario personal injury…

-Reduction from $100,000 to $50,000 for non-catastrophic claims, with an option to purchase increased coverage at additional premium. 

-All fees and expenses associated with assessments and reports in connection with accident benefits will be included in the $50,000 amount and will be applicable to the $1,000,000 available to catastrophic claimants. 

Caregiver and Housekeeping Benefits and Ontario personal injury…

·         For all non-catastrophic cases, housekeeping and caregiver benefits will  longer exist in a basic policy, and made optional with the payment of an additional premium.

·         For catastrophic cases, housekeeping benefits will only be available if they are “incurred” and there is a “substantial inability” to perform the housekeeping and home maintenance services normally performed before the accident.

Attendant Care Benefits and Ontario personal injury…

·         Reduction from half from$72,000 to $36,000 for non-catastrophic claimants, unless additional coverage. 

·         Payment will only be made when the benefit is “incurred”. 

Income Replacement Benefits and Ontario personal injury…

·         Reduced – 70% of gross income, rather than 80% of net income.  The maximum payable will remain at $400 per week, with the option of buying additional coverage of $600, $800, or $1000 per week. 

·         A limit of $2,500 is introduced for any accounting reports generated to determine entitlement.

Assessments and Ontario personal injury…

·         All assessment costs will be capped at $2,000.00 per assessment, whether at the instance of the insurer or the insured.

·         Payment for rebuttal examinations will be eliminated.

·         In-home assessments will be restricted to those who have sustained an impairment that is not a minor injury.

Definition of “catastrophic impairment” and Ontario personal injury…

·         The definition will be amended to include single limb amputees.

“Incurred Expense”  and Ontario personal injury..

·         The claimant will need to establish that the benefit for attendant care, caregiver or housekeeping was “incurred”, which includes the following:

- the insured person has received the goods or services to which the expense relates,

-the insured person has paid the expense, has promised to pay the expense or is otherwise legally obligated to pay the expense, and

-the person who provided the goods or services,

(A) did so in the course of his or her regular occupation or profession, or

(B) sustained an economic loss as a result of providing the goods or services to the insured person;

These changes will come in effect on September 1, 2010 and will have significant implications to all Ontario drivers, passengers and pedestrians. For more information visit www.ottawainjury.ca . 

David Hollingsworth has been an Ottawa Personal Injury Lawyer since 1999 dedicated to helping Ontario accident victims. For more information on how these changes affect you, visit www.ottawainjury.ca or call for free consultation 613 978-9549.