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 .
Ottawa accident Lawyer David Hollingsworth explains Ontario No-Fault Accident Benefits
Important: Report Your Accident!
The first step in the personal injury process is to report your accident! If you have been injured in an accident in Ottawa or Ontario, there are specific rules that must be followed to secure your personal injury claim. Your top Ottawa personal injury lawyer can help you through this process, to help you gain compensation for your injury, lost earnings, pain and suffering, or simply getting the insurance company to repair or replace your car. Remember, if you do not report the accident, the insurance company will not pay for any of these things enumerated. Top Ontario Personal Injury Lawyer David Hollingsworth can help you to ensure that you do not risk losing out on the many important benefits expanded upon below.
The “No-Fault” System of Insurance
In Ontario, we have a “no-fault” process or set of rules for auto accidents. These benefits are called “accident benefits” and basically mean that irrespective of who is responsible or “at fault” for the accident, you are still entitled to a large range of benefits to help you in a time when you are most vulnerable and need the benefits most. Generally, this system of insurance was introduced to provide accident victims with a large variety of benefits to foster their rehabilitation and to reduce the number of claims against insurers.
It is important to note, that such benefits do not cover damages for pain & suffering, or future income-loss. A lawyer will need to be retained if you want to claim for a tort action to recover for such things. A tort, in common law jurisdictions, is a wrong that involves a breach of a civil duty owed to someone else. It is differentiated from a crime, which involves a breach of a duty owed to society in general. A tort action is lodged against the driver who may have caused your accident. To succeed with a tort claim, your injuries need to be of a “serious and permanent” nature. This requirement of “serious and permanent” to claiming in tort is known as the “threshold”, subject to judicial interpretation and defined by the courts. A top Ottawa personal injury lawyer such as David Hollingsworth will the fluency to understand the fluid nature of the threshold, since the judicial interpretation of the threshold changes constantly. Your success depends on the facts of your case, and how the case is presented. Generally, a victim of an Ottawa personal injury or auto accident has two cases: first, a no-fault case against the insurance company and second, a tort case against the person or insurance company for the driver responsible for the accident. There may be an accident benefit claim and no tort claim or a tort claim and no accident benefits claim, and sometimes there is both a claim in accident benefits and tort. In short, your success depends on the facts of your case, the extent of the injuries, and the skill of your top Ottawa Lawyer. An experienced lawyer can help to explain the nature of the threshold, and it’s complexities to you so that you do not lose out on the benefits that you deserve.
Top Ottawa Personal Injury Lawyer David Hollingsworth can help you to recover accident benefits, including (1) Medical/Rehabilitative, (2) Income Replacement (3) Caregiver Benefits, (4) Housekeeping / Home-maintenance Benefits, and (5) Attendant Care Benefits.
(1) Medical/Rehabilitative Benefits
As the name implies, Medical and Rehabilitative Benefits are designed to deal with costs of treatment for physiotherapy, chiropractic, massage therapy, health club, adaptive/assistive devices, aquatic rehabilitation, and generally any other relevant treatments deemed reasonable and necessary for your recovery secondary to your accident. The list of features provided by these benefits is extensive, and can include devices such as therapeutic beds, wheelchairs, canes, ramps and even modified vehicles to accommodate for your accident injuries. A health care professional like a physiotherapist, massage therapist or a doctor must complete a “treatment plan” for you in order to recover these benefits. This is form is submitted to the insurance company for consideration. Generally, accident victims in a “non-catastrophic” cases are entitled to a maximum of $100,000 in benefits over 10 years in med/rehab benefits. Accident victims in “catastrophic cases” are entitled to a maximum of $1,000,000 over the course of a lifetime.
(2) Income Replacement Benefits
Income replacement benefits are designed to replace your income if you are not able to work secondary to your accident. Generally, there is an 80% entitlement to your net pre-accident income (which is averaged from your last year’s pre-accident earnings, or 26 of the 52 weeks before your accident). Generally, the maximum allowable income replacement benefit under a standard automobile insurance policy in Ontario is $400/Week. Issues can arise in claiming income replacement benefits when it is difficult to prove that you were working before your accident, or quantifying your pre-accident income, and so on. An experienced lawyer can help you in this regard because they will know the “ins and outs” of the entitlement opportunties for you.
(3) Caregiver Benefits
Caregiver benefits are designed for individuals who were the primary caregiver for a dependant, such as a young child, elderly person or sick person, at the time of their injury. Due to the injury or accident, these individuals are not able to care for their dependants any longer and require caregiver benefits. Generally, you do not need to show that you made any income prior to your accident. Rather, you are only required to demonstrate your status as the primary caregiver. As to weekly benefits, the caregiver is entitled to about $250/week, with an additional $50 for each extra dependant. A good lawyer will know these details about your benefits and can help you get the benefits you deserve.
Housekeeping/Home-maintenance benefits are designed to help the accident victim to complete necessary chores, housekeeping or home-maintenance, including the cleaning of dishes, preparation of meals, general cleaning like dusting, mopping, taking out the garbage and so on, which become impossible in situations of physical impairment and injury following your accident. These benefits are generally $100/week and can be claimed by submission of appropriate receipts and invoices to your insurance company. If you do not submit these required documents to your insurer, you will not get these benefits, regardless of how hurt you are. A compassionate lawyer will understand the difficulty you may face with the stress of your injury and can help you to work out a plan so that you are not losing out on any benefits that you deserve.
(5) Attendant Care Benefits
Attendant Care Benefits are designed to compensate for individuals such as your family, friends, loved ones, or whomever is performing attendant care services for you after your injury. These benefits are designed to pay these individuals for their services, which after a tragic injury can include grooming, bathing, grocery shopping, brushing hair, putting on clothes, brushing teeth etc, when the accident victim is no longer able to do so secondary to their accident. As in the other benefits, a lawyer can help you to recover these costs. The process involves enlisting the services of a health care professional (e.g. occupational therapist, etc) to complete a “Form 1”. This form will describe the extent of help and care requirements a victim needs following their injury.
In short, if you or a loved one has been injured in a motor vehicle accident you may be entitled to many accident benefits from your insurance company. Each year, thousands of victims neglect to see a top Ottawa Lawyer and lose out on many benefits that they deserve that could help them in their recovery. Top Ontario Personal Injury Lawyer David Hollingsworth can help you to ensure you protect and safeguard your interests by recovering your benefits, which can include (1) Medical/Rehabilitative, (2) Income Replacement (3) Caregiver Benefits, (4) Housekeeping / Home-maintenance Benefits, and (5) Attendant Care Benefits. If you do not have insurance, you may still be entitled to these benefits. As an experienced Ottawa personal injury lawyer, David Hollingsworth speaks and meets with people daily who have not been properly compensated by their insurance company. David Hollingsworth knows the system and is here to help you. You have been through an accident; you have been through enough. Visit www.ottawainjury.ca or email [email protected] for a free consultation.
-David Hollingsworth, Ottawa Personal Injury Lawyer