Catastrophic Injury and Non-Catastrophic Injury: STATUTORY ACCIDENT BENEFITS
Did you know that regardless of who is at fault, people injured in motor vehicle accidents in Ontario may be entitled to certain accident benefits from their own motor vehicle insurance company regardless if they have suffered a catastrophic injury or not?
Even if you do not have car insurance, if you suffer personal injury in a car accident , you are entitled to receive compensation from the Ontario government.
Effective September 1, 2010, the SABS or Statutory Accident Benefits Schedule states that among other Ontario accident benefits available, Ontario accident benefits include:
- an Income Replacement Benefit of up to $400 per week,
- an Attendant Care Benefit of up to $3,000 per month with a maximum of $36,000, and
- Medical and Rehabilitation Benefits of up to $50,000 over a 10 year period following an Ontario accident.
If a person dies in an Ontario motor vehicle accident, Ontario accident benefits are available for Funeral Expenses as well as a Death Benefit.
If the personal injury is more serious and is deemed within the definition of “catastrophic impairment injury”, there is an increase to:
- $1,000,000.00 in Medical and Rehabilitation Benefits and
- $1,000,000.00 in Attendant Care Benefits which are payable over the course of an injured person’s life.
People who have suffered catastrophic injury are also eligible for Case Management Services as well as other Ontario accident benefits such as Housekeeping and Home Maintenance Benefit of $100.00 per week payable for the duration of their lifetime.
What is the difference between a Catastrophic injury and a Non-Catastrophic injury?
Let’s start by looking at the Ontario accident benefits…
What are NON-CATASTROPHIC benefits?
- Income Replacement Benefit – 80% of net weekly income up to maximum of $400.00 per week to a maximum period of 104 weeks.
- Non-Earner Benefit – $185.00 per week to a maximum period of 104 weeks.
- Caregiver Benefit – $250.00 per week for 1st child and $50.00 per week for each subsequent child to a maximum period of 104 weeks. Only applies for children under the age of 16.
- Attendant Care Benefits – $3,000.00 per month maximum to a maximum period of 2 years.
- Medical and Rehabilitation Benefits – $50, 000.00 maximum. 10 year maximum period.
What are CATASTROPHIC INJURY benefits?
- Medical and Rehabilitation Benefits – $1,000,000 to use over the course of the injured person’s life.
- Attendant Care Benefits – $1,000,000 to use throughout life. Monthly payment maximum is $6000.00
What are these Ontario Accident Benefits?
- Income replacement benefits help replace lost income if an employed or self-employed claimant is disabled.
- Caregiver benefits pay certain childcare or other caregiver expenses if a stay-at-home parent or other caregiver is unable to care for a child or other person in need of care.
- Non-earner benefits are paid if a claimant who is not employed or self-employed is unable to carry on with normal life.
- Medical and rehabilitation benefits pay for treatment and rehabilitation assistance that is not covered by OHIP or another disability insurance plan.
- Attendant care benefits pay for someone to look after a seriously injured claimant.
- Funeral expenses and death benefits are paid if an insured person dies as a result of the accident.
Depending on your circumstances, you may also be entitled to other benefits, such as payments for lost education expenses, housekeeping assistance, visitors’ expenses, repair or replacement of eyeglasses or clothing damaged in the accident, or case management services.
Each and every case is different and to know exactly what you are entitled to, it is best to consult an Ontario personal injury lawyer specializing in Ontario car accidents.
Ottawa accident Benefits Lawyer David Hollingsworth, Ottawa Accident Lawyers.
Who is entitled to Ontario Accident Benefits? Ontario Accident benefits are available to people suffering from personal injury in a motor vehicle accident in Ontario. Often after being discharged from an Ottawa rehabilitation centre, (The Ottawa Rehabilitation Centre, The Ottawa Hospital-Civic Campus or Elizabeth Bruyere, in Eastern Ontario) , people with personal injuries will return to their homes only to find that their home needs modifications and their home cannot accommodate them. The Statutory Accident Benefits Schedule (SABS) is available to motor vehicle (car accident, boating accident etc.. victims in Ontario to help with these modifications.
Accident Benefits Schedule: Typically, Ontario car accident victims can receive accident benefits. Normally, these accident benefits are covered by the injured person’s own insurance company. However, accident benefits also provide coverage for people who do not have their own insurance. Typically, statutory accident benefits are there to replace lost wages, attendant care benefits, rehabilitation and medical benefits as well as wrongful death benefits.
Housing: The insurance company must pay the injured person for all reasonable and necessary home modifications and home devices, including communication aids. Ontario’s statutory accident benefits permits an injured person to buy or renovate a new home to meet his or her needs where that is the option that makes more sense than renovating an existing house. Having said that, the money alloted for the purchase of a home cannot be greater than the estimated cost of any renovations that would be needed to meet the injured victims needs.
The medical and rehabilitation benefits are supposed to pay for all reasonable and necessary expenses that arise because of the accident. Home modification comes under the medical / rehabilitation category.
After September 2010, this information will change. For now, if the injured person did not suffer a “catastrophic impairment” as that is described in the Accident Benefit regime, the total amount of the medical / rehabilitation benefit is $100,000 and the benefits expire after 10 years from the date of the accident. If the injured person did suffer a “catastrophic impairment” the medical / rehabilitation benefit increases to $1 Million and last for the duration of the victim’s life.
Timelines: It is important you notify your insurance company that you have had an Ontario accident within 7 days of the Ontario accident, or as soon as possible, and you must complete your application for Accident Benefits within 30 days of the Ontario accident.
What is an assessment? The assessments give suggestions to assist a person who is injured how to live safely and comfortably in their home if possible. The assessment focuses on returning the person who is injured to a level of function that approaches his or her pre-accident state to the extent that that can be done safely.
People who suffer a catastrophic injury may also need additional assessments . The assessments will result in a report. After the report is written, another form called a “OCF 18: Treatment Plan” will be submitted to the insurance company, outlining the proposed cost of the recommendations in the report. If the OCF 18 is approved, the work can begin.
Are home modifications limited to catastrophic injuries? Sometimes. Where the injured person has suffered personal injury that cause impairment but are on the less serious end of the spectrum, and if the renovations are not going to be extensive, an occupational therapist can perform a home assessment.
An assessment of the activities of daily living of the injured person is included in a home assessment. This assessment looks at personal care, housekeeping, home maintenance and care giving tasks. The report written by the occupational therapist will outline a list of any assistive devices and changes required to the home. For example: a railing, raising or lowering a bed or counter or adding hip-level storage in a kitchen.
If the recommended renovations included in the report are complete, it is submitted to the insurance company together with a Treatment Plan costing the recommendations to the insurance company for approval. If a person has serious personal injury and needs significant home modifications like ramps, additions, elevators, walls moved, a home accessibility report is required. For more information regarding Ontario insurance claims, visit www.ottawainjury.ca .
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.