Understanding your Accident Benefits Following Changes to the Ontario Statutory Accident Benefits Schedule
Catastrophic Injury Victim Beware ! In an effort to make insurance more affordable for all Ontarians, the Ministry of Transportation made some large scale changes to accident benefits coverage last June. These changes have reduced, changed and, in some cases, eliminated coverage. In particular those impacted by a catastrophic injury are most at risk.
As many drivers do not regularly review the their policies, they may not be aware of the impact of the new lowered benefits. Many will find out only when an accident happens. Then it is too late.
Want to be covered in the event of a catastrophic injury ? Always best to check with your insurance company
Our Ottawa injury lawyers wrote about the changes when the new legislation took effect. At that time, we encouraged readers to make a thorough review of their existing policies and encouraged them to purchase additional coverage.
Our lawyers have received many questions about Insurance coverage since the changes took effect in June. While the outlines provided by the Ministry give a fair rundown of what is covered and what is not covered under the new standard policy, many drivers remain confused about the definition of catastrophic injuries. The term catastrophic determines the type of benefit available, but its definition is not clear in the material provided with the standard insurance policy.
What is considered a catastrophic injury ?
If an injury will have a lifelong impact on the victim’s quality of life, it can be deemed catastrophic. If the victim is left a paraplegic or quadriplegic or requires the amputation of an arm or leg, if the injury causes serious traumatic brain injury or if the victim suffers loss of vision the injury would most likely be classified as a catastrophic injury. Sadly, people with these catastrophic injuries are the ones who need insurance coverage the most and now, with the changes, they are losing many of their accident benefits.
Once someone’s impairments are considered a catastrophic injury the victim may be eligible for the additional benefits including:
- $1,000,000.00 for Medical Rehabilitation and Attendant Care combined (up to $6,000 per month)
- Housekeeping (up to $100 per week for life)
- Income Replacement Benefit (to a max of $400 per week for life)
- Non-Earner Benefit (up to 104 weeks after the accident up to $185 per week)
- Visitor Expenses
- Entitlement to a Case Manager
- Lost Educational Expenses (up to $15,000)
- Payment for clothing, prescription eyewear, dentures, hearing aids, prosthetics and other medical or dental devices damaged as a result of the car accident
- Reimbursement for travel to and from medical appointments
- Caregiver Benefits
These definitions may be difficult to interpret and it is always advisable to consult a personal injury lawyer as soon as possible after a serious accident.
Changes to Accident Benefits Means Reduction in Coverage for Ontario Drivers
Do you know about the changes to accident benefits? When accidents happen, we expect that our health care system will be there to provide only the best care to see us through, but what about all of the other expenses that are not covered under the Ontario Healthcare System? Few of us stop to consider who will pay for replacement income if we cannot work, childcare as we recuperate, rehabilitation and home maintenance? Are these expenses automatically covered by our insurance policies? Yes, they are and they fall under the Statutory Accident Benefits Schedule.
New Changes to Accident Benefits: Will you be covered?
Statutory Accident Benefits apply to anyone involved in a car accident, bicycle accident, motorcycle accident, pedestrian & car accident and any other type of motor vehicle accident. These benefits fall under the Insurance Act of Ontario and apply to:
- Income Replacement Benefits
- Non-Earner Benefits
- Caregiver Benefits
- Housekeeping and Home Maintenance Benefits
- Attendant Care Benefits
- Medical and Rehabilitation Benefits
Will you have enough coverage?
On June 1, 2016, the changes to accident benefits and coverage in standard auto insurance policies was implemented to help make insurance more affordable. Some claim amounts were reduced and some options for increased coverage were eliminated or changed.
This is an overview of the changes to accident benefits.
- Medical & Rehabilitation and Attendant Care benefits have been combined into one category.
- Persons with catastrophic injuries may be entitled to a maximum combined benefit of up to $1,000,000 over their lifetime. This has been reduced from $2,000,000.
- Persons with non-catastrophic injuries may be entitled to a maximum combined benefit of up to $65,000 over 5 years reduced from $50,000 over 10 years for Medical, Rehabilitation and $36,000 for Attendant Care over 2 years.
- Persons with minor injuries may be entitled to a maximum benefit of $3,500. The claim period has been reduced from 10 years to 5 years.
In order to meet the definition of catastrophic for car accident cases in Ontario, a licensed doctor must complete and submit an OCF-19 form. This form is called an Application for Determination of Catastrophic Impairment. Given that the Statutory Accident Benefit amount vary greatly depending on which category the victim may fall under, it is important to learn more about the difference between catastrophic injury accident benefits and non-catastrophic injury accident benefits .
Should you purchase additional coverage?
In addition to these changes came the opportunity to purchase Optional Benefits for Medical, Rehabilitation and Attendant Care. You may want to purchase optional benefits to increase coverage levels, but first take time to understand your existing plan and impact the of the new changes.
- Read your policy and compare it to the new policy to see what changes have been made. If you have benefits from your employer or another policy, you may already have some level of coverage for some or all of the changes made. You should consider these benefits as you review your coverage options.
- Understand your policy. Call your insurance representative and ask questions, or do some additional reading, to make sure you understand your insurance and what your coverage means. Make sure you know what options are available to increase or purchase other benefits, or to reduce premiums by increasing deductibles or taking advantage of discounts.
- Shop around. There are many insurance companies competing on price and service in Ontario, and you should make sure that you compare at least three quotes for the same coverage before making a decision.
If you or a loved one has been injured in an accident, it’s important you get the information you need. Ontario Accident Benefits are your benefits and benefits you are most likely entitled to. If you are unsure of your rights or what benefits you are entitled to, contact our personal injury lawyers and we will be happy to provide you with the information you need to get the benefits you deserve.
Changes to accident benefits
I received my letter today. “Changes to Ontario Auto Insurance Give You More Choice” Ha ! It seems like every so often there are new cuts and changes to accident benefits in Ontario and this year is no different. While it is mandatory to purchase auto insurance in Ontario, the mandatory coverage seems to be eroding. Sadly, these changes are leaving many vulnerable accident victims with little resources or compensation to rely on. Not to mention, these are much needed resources.
As of June 1, 2016 there are more drastic cuts coming to Ontario’s accident benefits system. You may recall that Ontario residents also saw very drastic cuts to their accident benefits on Sept. 1, 2010. Those initial cuts stripped many accident victims of services and compensation they needed for recovery and now even more accident victims will find themselves with no income, less compensation and fewer accident benefits.
The insurance company’s response to changes to accident benefits ? Buy more insurance…
Sadly , the Ontario insurance regime has been so eroded that for some, there simply isn’t enough benefit coverage for people who are injured in a car accident and need to access these benefits. The government and the insurance industry’s response to this has been to tell Ontario drivers to purchase optional benefits. In other words, give more money to the insurance companies, while the government mandates fewer and fewer benefits. The upcoming changes have also made it next to impossible and extremely difficult for Ontario accident victims to access help in a timely manner. Now, anyone who may be deemed to have a catastrophic impairment, must wait and be tested several months, or even years after they have suffered their injury. In the meantime, they aren’t able to work and their bills are piling up. We don’t need to elaborate on how difficult a situation this is on a family or an injured individual.
Insurance companies can pay low wages
Insurance companies also have stipulated limits as to what they are willing to pay. Even if an accident victim is eligible for certain benefits such as having someone come into their home to help, the insurance companies often set a dollar amount as to what they will pay for these services. Often times the dollar amount is too low, making it difficult to find help and people who are willing to work for low wages.
Perhaps one of the most disturbing new regulations being introduced is a new law that strips away the rights of Ontario drivers. Now, there is no real recourse against the insurance companies if they are being unfair and mishandling a claim. Before this new law, drivers in Ontario were permitted to sue the insurance company if the insurance company was being unfair and mistreating an individual. Now, the government has removed the right to sue. Sadly, this may give the insurance companies a lot of room for misconduct.
Insurance companies can hire their own
Another huge inequity is that insurance companies are able to hire their own professionals to assess accident victims . The cost of these assessments is very expensive. Ultimately these are dollars that could be given to accident victims for rehabilitation, home modifications etc…
“Stay tune for more changes to accident benefits…”
It really seems like it can’t get worse for Ontario drivers. Ontario drivers are paying a lot of money for mandatory insurance that will likely not cover the cost of their injuries and they will likely not have access to the much needed funds they will need in time. One has to ask oneself…..When is enough, enough ?
written by Rebecca
Ottawa Injury Lawyers David Hollingsworth
We hate to be the bearer of bad news but we are today. The Ontario government has done it again. To further add to all the reductions in accident benefits that have been made over the last while, they announced even more changes last Thursday. These changes, in our opinion negatively impact Ontario drivers.
The changes are known as “The Fighting Fraud and Reducing Automobile Rates Act” and it was passed last week. What’s most disturbing in this Act is the removal of the right of motorists to sue an insurance company after they have been denied their claim. This new Act , in our opinion does not favour Ontario drivers and although it says it is designed to benefit drivers, removing the right to sue , will leave many Ontario claimants out of luck and in a potentially bad situation , where they are injured but the insurance company is not going to cover their injuries. It seems at every turn there are further and further reductions in Ontario Accident Benefits and now further rights are being removed.
Another change that Ontario drivers are facing is that the government has also reduced the interest rates that injured Ontario drivers and passengers get on their compensation from insurance companies which was reduced from 5% to 1.3% . This reduction in interest unfortunately can hurt Ontario drivers , as it gives less incentive for insurance companies to settle with claimants due to a lower interest rate.
Reducing Insurance Fraud. Really ?
The Ontario government would have us believe that their goal in this Act is to reduce insurance fraud and reduce insurance costs, but there is much more at play. So far the “promised 15 % reduction in insurance fees” has yet to be seen . The Toronto Sun reported that premiums have dropped by an average of only 6 %: a far cry from 15% !
The Importance of Accessing all Ontario Accident Benefits
We don’t disagree that automobile insurance is very expensive and lowering insurance premiums is important. What is even more important in our opinion is the ability to access ALL the accident benefits. We work each and every day with people who need these Accident Benefits not only for medical bills but also for expenses such as caregiver expenses, loss of income , etc.. Without access to these benefits, there are many people who will continue to suffer after an accident.
With further and further reductions in Accident Benefits what will be the end result? We don’t think it’s heading in a good direction at all. The Ontario Insurance Regime continues to change and Ontario drivers continue to have their rights and benefits reduced. This is frightening.
Our Ottawa Personal Injury Lawyers Are Here For You
If you have questions regarding Ontario insurance or making an accident claim, our lawyers and accident benefit specialists are here to help. Contact us for a free consultation or visit our website for more information.
Ottawa Insurance Claims Lawyers David Hollingsworth
In September 2010, The Ontario government through the Financial Services Commission of Ontario made significant changes to Ontario insurance plans. Not only did FSCO significantly reduce the accident benefits available to Ontario drivers, it introduced a 2 tiered approach for Ontario drivers. All Ontario drivers are required to purchase insurance. How much insurance you purchase is up to you.
Top up accident benefits
There are several “top ups” that can be purchased in the event that you or a loved one is in an accident in Ontario. Indexation is an additional Ontario accident benefit that can be purchased. This optional benefit provides for an automatic adjustment over time of several different accident benefits including income replacement benefits, medical and rehabilitation benefits, attendant care benefits and other Ontario accident benefits. The indexation of these accident benefits is determined by the changes in inflation based on Consumer Price Index of Canada. Basically, it’s an extra insurance policy that ensures that your benefit dollars keep up with the times.
Accident Benefits and Indexation
In other words, a dollar today is not going to be worth what a dollar tomorrow will be worth. As an Ottawa personal injury lawyer, I know how important Ontario accident benefits are to my clients. Often times, people are unable to return to their previous life before the accident and are left with their insurance claim and accident benefits to carry them throughout the rest of their lives. I know that Ontario insurance premiums are already very high, so paying even more is frustrating; however, if ever you need to access these accident benefits, you will need them.
Our personal injury lawyers are constantly meeting with people who regret not having “topped up” their insurance coverage. It’s a personal decision and not a decision that should be taken lightly.
Something to think about…
Ottawa Ontario Insurance Claims Lawyer David Hollingsworth Ottawa Accident Lawyer, Ottawa Personal Injury Lawyer David Hollingsworth- ..I know I keep harping about the upcoming changes to Ontario car insurance, but I am concerned and want to make sure you have a clear picture of what is going on for Ontario drivers. It is important that you make an informed decision, when it comes to renewing your Ontario car insurance…
A serious personal injury claim is much more expensive than the cost of most vehicles. The most serious of personal injuries are not common, but could cost more than several vehicles. Personal injury is reported in 54 % of private passenger car (this includes motor vehicles) accidents covered by car insurance. Nearly 1/2 of those personal injuries are more than minor.
Insurance claims companies reported 71,803 personal injury claims for Ontario accident benefits among the 138,568 property damage and collision claims involving Ontario’s more than 6 million insured, private-passenger vehicles in 2009. What does this mean? Based on the figures Dominion reports, there would have been nearly 39,000 minor personal injuries, more than 30,000 more serious personal injuries and more than 5,500 of the most serious personal injuries. It’s important that drivers become more familiar with the Ontario personal injury coverage they now get with the mandatory portion of their car insurance, and what amounts they will soon have the option to buy.
Ontario Drivers renewing their car insurance after Sept. 1, 2010 may choose to buy $50,000 of medical and rehabilitation coverage, or pay extra to continue to have $100,000 over coverage for personal injuries that are neither minor nor catastrophic personal injury.
Ontario is the only province with privately delivered insurance that allows the purchase of additional coverage. It will still be possible to buy $1 million of medical coverage instead of either the $50,000 or $100,000 limit. No matter what amount of coverage you have now, or choose to buy later, there will be a $3,500 limit on coverage for treatment of most minor personal injuries starting Sept. 1.
Other coverages, such as for housekeeping and child care while you are injured, will become optional and at an additional cost. In my opinion, as an Ottawa Ontario personal injury lawyer, if you can afford this, it is well worth it, when you need it most. The Financial Services Commission of Ontario (FSCO) is expected to release its next quarterly report on the averages of approved rate changes sometime this month. Some time after that, Ontario insurance claim agents and brokers will be able to tell Ontario insurance policy holders about the sort of rate changes they are facing.
Many Ontario insurance companies have already begun publicizing these new changes and how they may “save” you money, when renewing your Ontario insurance; however keep in mind that the reduction you might face in payments, is minimal to the reduction you may face if ever you are involved in an Ontario car accident and have serious personal injuries. Remember, the personal injury coverage is far more important than the coverage on your vehicle.
Please pass this on to anyone in Ontario who walks, drives, bikes, or rides !It affects us all..
If you have any questions, or need more information, visit www.ottawainjury.ca I would be happy to answer any other questions you may have,
David Hollingsworth, Ottawa Personal Injury Lawyer, serving Alexandria, Arnprior, Belleville, Brockville, Clarence Creek, Cornwall, Embrun, Gananogue, Hawkesbury, Kemptville, Kingston L’Orignal, Morrisburg, Napanee, North Gower, Pembroke, Perth, Peterborough, Picton, Prescott, Renfrew, Richmond, Russell, Smith Falls, and Tweed and all cities, communities, districts, municipalities, regions, towns, townships and villages in between.
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.