Changes to Statutory Accident Benefits Schedule and Catastrophic Injury
Automobile insurance is constantly changing . It seems that the government continues to strip away at some of the most vital services required for injured people, especially those who are severely injured and need it most, those with a catastrophic injury. The new definition will apply to all accidents in Ontario on or after June 1, 2016. The Statutory Accident Benefits Schedule (“SABS”) provides accident benefits for people who are involved in a motor vehicle accident in Ontario. Regardless of whether or not they were at fault, or whether or not they were a driver, passenger or a pedestrian.
Definition of Catastrophic Injury Impairment
Many of the changes are in the area of Catastrophic Injuries. The most significant of the reductions in Accident Benefits are in the Medical and Rehabilitation and Attendant Care benefits for individuals with catastrophic and non-catastrophic injuries.
There are also new measures used to assess whether or not someone is deemed “catastrophic”.
1- Paraplegia or Tetraplegia
The two scales or measures that are the primary source for the catastrophic determination for spinal cord injuries are the The ASIA -International Standards for Neurological Classification for Spinal Cord Injury as well as the SCIM Spinal Cord Independence Measure Version III The definition of “catastrophic impairment” has been revised to reflect current medical studies.
2-Residual Neuro-Urological Impairment or Urological Impairment
3-Loss of vision of both eyes
4-Traumatic Brain Injury
When assessing whether or not a patient has sustained a catastrophic brain injury, the appropriate health professional must conduct, among other things, the following clinical interview: a Structured Interview for the Glasgow Outcome Scale.
5-Traumatic Brain Injuries for person under the age of 18 at the time of the accident
The scale is dependent upon imaging of the brain, extent of admission to a rehabilitative facility and the King’s Outcome Scale for Childhood Head Injury, as published in Crouchman, M. et al
And where 2 or more years have elapsed since the accident, or where, after 3 months, a physician is of the belief that the patient’s condition is unlikely to improve and,
6- Physical Impairment
55% or more physical impairment of the whole person pursuant to the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th Edition (1993)
7-Mental or Behavioural Impairment Combined with Physical Impairment
A mental or behavioural impairment, excluding traumatic brain injury, that, when the impairment score is combined with a physical impairment described in paragraph 6, results in 55 percent or more impairment of the whole person.
8. Mental or Behavioural Impairment
An impairment that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993 results in a class 4 impairment (marked impairment) in three or more areas of function that precludes useful functioning or a class 5 impairment (extreme impairment) in one or more areas of function that precludes useful functioning, due to mental or behavioural disorder.
Along with these tests, a patient must also undergo a neuropsychological assessment and must meet the following criteria to obtain what is deemed “catastrophic status”. The patient must have positive MRI findings, vegetative or disability rating on the Glasgow Outcome Scale (as mentioned above) , significant decreased activities of daily living via client interview, interview of treating practitioners (mentioned above) and/or a file review of collateral medical documents.
The definition and criteria for a catastrophic injury can be confusing and complex. We have provided a quick snapshot here. Our personal injury lawyers are happy to speak with you to go over any specific questions you may have.
What are Accident Benefits ? Have you been in accident? Are you wondering what your options are? In most cases if you reside in Ontario you may be entitled to Accident Benefits. The Statutory Accident Benefits Schedule, otherwise known as SABS is the provincial regulation of benefits. These are standardized benefits that all insurance companies in Ontario provide. The role of Accident Benefits is to provide insurance compensation, regardless of fault, if you, your passengers, or if you are a pedestrian and have suffered a serious injury in an accident. Depending on the nature of the accident and the extent of the injuries, certain relatives or dependents may also qualify, even if they were not directly involved in the accident. You may also qualify for accident benefits if you were not directly involved in an accident but are suffering from psychological and mental strains of injured relatives.
Not everyone is entitled to Ontario Accident Benefits. You may apply for Accident Benefits and your insurance company and may deny your coverage. You can appeal this decision and fight it. An experienced personal injury lawyer can assist with this type of appeal and will work towards getting you maximum compensation and the benefits you need.
Who is excluded from Ontario Accident Benefits?
An insurance company may deny Income Replacement Benefits, Non-earner Benefits and compensation for other expenses benefits to:
• a driver who was excluded from an insurance policy,
• a driver or passengers who were aware, or should have been aware that the vehicle was driven without the owner of the vehicle’s consent,
• anyone who made false misrepresentation to their insurance company , resulting in automobile insurance being provided, and
• anyone who at the time of the accident was involved in an act for which he or she is convicted of any criminal offence, regardless of whether or not the offence is related to the operation of a vehicle,
• a driver who knew, or out to have known, that they were driving without a valid insurance.
If you or a loved one has been injured in an accident, it’s important you get informed. 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 would be happy to provide you with what benefits you are entitled to and give you an idea of what type of compensation you can expect
Ontario Accident Benefits Insurance Claims David Hollingsworth Personal Injury Lawyers. The Ontario insurance regime is one of the most complicated insurance regimes in North America. When it comes to car insurance, you certainly don’t want to scrimp but you always don’t want to pay extra money if it’s not needed. Sadly, when it comes to choosing optional accident benefits, many people will automatically settle for basic coverage. As an Ottawa personal injury lawyer, I can tell you, this may be a huge mistake.
Now, the truth is hopefully you will never need to access your accident benefits . Great ! If you do however get injured in an accident, you may find yourself unable to work, injured, in a home that needs modifications and that’s when you want to make sure you have access to as much accident benefits compensation as possible. Sadly, most people don’t really know what their accident benefits insurance coverage is until they really need it.
A basic auto insurance policy in Ontario contains far less accident benefits coverage than a policy where the “top-ups” have been purchased. Along with this decrease in benefits comes a decrease in yearly premium payments. Many will opt for this. I would caution you not to. I urge everyone to speak with their broker and find out what optional benefits are available to you and at what cost.
For instance the Medical and Rehabilitation Benefits jump from $100,000 to $50,000 or possible even $ 3,500 if you have purchased the optional benefit.
If you purchase additional accident benefits, you can be entitled to Housekeeping Benefits and Caregiver Benefits , which have been eliminated in the basic policy.
Attendant Care Benefits are another optional benefits that can be purchased and allow you to have access to $72,000 instead of $36,000. You may have access to additional accident benefits through your work and in this case may not require purchasing additional accident benefits.
It’s important to know what options you have and choose what’s best for you and your family. Another important piece of information you need to know is that if you have more than one vehicle, you only need to purchase these additional accident benefits for one vehicle only.
In my opinion, the top up amounts are well worth it. An average vehicle can purchase most additional accident benefits for under $200 a year. That $200 a year translates to a significant amount of money if you need, when you really need it. I cannot tell you how many personal injury cases I have settled where people have given additional much need funds and they are so thankful that they purchased those additional accident benefits. Talk to your broker about what options you have and what accident benefits are available to you. To read about some of the accident benefits settlement amounts we’ve secured for our clients visit http://www.ottawainjury.ca/cases
Ottawa Personal Injury Lawyers David Hollingsworth and Associates. What injuries are deemed a catastrophic injury? What is the definition of a catastrophic injury? Well, it has changed and changed for the better….In an interesting case Pastore v. Aviva Canada, the Court of Appeal of Ontario ruled that an injured victim does not need to be markedly impaired in more than one area of life to be deemed ” catastrophically impaired”. In this particular case, the injured party had been hit in a car accident in November 2002 . As a result of the accident, her left ankle was broken and over time her ankle healed improperly. The injured victim had a number of surgeries and consequently her right knee also required surgery due to the injuries in her ankle and the manner in which she now walked. As a result of these injuries, the victim became dependant on others for everyday activities she once was able to perform on her own. This dependency also affected the victim’s emotional and psychological well-being.
In May 2005, the victim Ms. Pastore applied to the Aviva insurance company to have her injuries deemed as a “catastrophic impairment” and it was determined that she had a catastrophic impairment : “mental or behavioural disorder.” It was deemed that Pastore had a class 4 or “marked impairment” due to her daily living and she was rated with an overall assessment of class 3, which is a moderate impairment. What this meant was that she was now meeting the threshold for a catastrophic impairment in one category. A catastrophic impairment designation requires impairment in all four categories. The case was brought to the Court of Appeal and it was there decided that Pastore’s position, according to the language in the Statutory Accident benefits did not require “marked impairments” in each of the four categories of a catastrophic impairment designation.
This is excellent news for Ontario accident victims. This decision allows for additional Ontario accident benefits for injured victims. We have many clients who thanks to this decision, will be able to receive the help and support they need. This is great news for Ontario accident victims and their families. Many accidents leave people with physical injuries , but also injuries such as chronic pain, and emotional and psychological impairments . Thanks to this decision, there will be increased benefits for people suffering from these impairments.
David Hollingsworth and Associates . We are Ottawa injury lawyers with a wealth of experience . Our lawyers work closely with you our clients to make sure no stone in unturned and that our clients receive all the support and compensation they need following an accident in Ontario. If you are injured, it’s important that you meet with an experienced Ottawa personal injury lawyer who knows how best to help you. There is far too much at stake to be with the wrong lawyer. We pride ourselves on our high success rate, our experience and our valuable relationships with our clients. Your future and your families future is important and we understand that. We are here for you and with you every step of the way. Contact us for a free consultation. Visit www.ottawainjury.ca or email [email protected]
We understand, we care, we’re here to help …and our track record proves it.
Ottawa Injury Lawyers David Hollingsworth and Associates. If you have been in an accident in Ontario and are injured, you will most likely need to access your Ontario accident benefits. Ontario accident benefits are provided through your insurance company or the insurance company of other vehicle involved in the accident. You begin by first informing your own insurance company that you have been in an accident. They will then send you an Ontario Accident Benefits package. By law your insurance company must provide you with these forms, and you have 30 days to complete the necessary accident benefit forms and return them to your insurance company. It is important you fill out these forms are properly filled out. When a new client comes to us and we act for them as their Ottawa personal injury lawyer, we always recommend that we fill out the forms for them as often times they can be somewhat confusing and challenging if you have never filled them out before. We have accident benefit specialists who can fill these form out for you in a comprehensive and detailed manner ensuring that there are no errors on your forms that could in turn delay your case. There are a number of Ontario accident benefit forms that need to be completed and depending on what your injuries are and the details of your accident, you may be required to fill out all of them. The primary forms that need to be filled out right away are:
Ontario Accident Benefit Forms: OCF Forms
- OCF-1 : Application for Accident Benefits
- This is the initial accident benefits form to be filled out when applying for accident benefits as a result of an accident . The OCF-1 form must be filled with your insurance company in order for your personal injury claim to commence.
- OCF-2 Employer’s Confirmation of Income
- The OCF-2 form applies only to those who are claiming Income Replacement Benefits. The OCF-2 form is completed by you and your employer. There are instances where several OCF-2 forms need to be completed. For example if you have been employed by more than one employer in the previous 52 weeks, you may need to fill out an OCF-2 form for each of your previous employers within the previous 52 weeks.
- OCF-3 Disability Certificate
- The OCF-3 form is to be completed mainly by your health practitioner. It needs to be as detailed as possible and describes the extent of your injuries as a result of the accident.
- OCF-5 Permission to Disclose Health Information
- The OCF-5 forms allows for access to your medical records and any previous medical information that can help determine your accident benefits eligibility.
You have been injured and you are suffering so its important that we get you help as quickly as possible. We are Ottawa personal injury lawyers who can help you by ensuring that you receive all the services you need as well as ensure that you receive maximum compensation for your injuries. Our accident benefit specialists will help you sift through the accident benefits process and will complete all the necessary Ontario accident benefit forms properly and in a timely manner, so as not to delay your case. We understand that these are difficult times and we are here to help. Our Ottawa injury lawyers can travel to you, your home or your hospital. All consultations are free.
Ottawa Personal Injury Lawyer David Hollingsworth, Ontario Injury Lawyers, Income Replacement Benefits..Often times after suffering a personal injury in a motor vehicle accident you may not be able to return to work right away. You also may not be able to provide for yourself and your family. Depending on the severity of your personal injuries, you may not be able to work for a few days, maybe a few months or perhaps even longer. This is very stressful and this is where income replacement benefits comes in.
What are Income Replacement Benefits?
Income Replacement benefits are available to Ontario personal injury victims who were employed or self employed at the time of the motor vehicle accident in Ontario and who, as a result of the personal injuries sustained in the Ontario accident, “suffer a substantial inability to perform the essential tasks of their employment”. This is the definition that applies for the first 2 years following a car accident in Ontario.
Following 2 years after an Ontario accident, it changes and becomes much more difficult to qualify for income replacement benefits. To continue to qualify for income replacement benefits, Ontario accident victims must have “a complete inability to engage in any employment or self-employment for which they are reasonably suited by education, training or experience.”
How much do Ontario accident victims get for Income Replacement Benefits?
The amount of income replacement benefits received depends on a number of different factors such as one’s income before the accident. As well as whether or not you opted to purchase additional accident benefits.
- For motor vehicle accidents occurring after September 1, 2010, the amount of the weekly income replacement benefits is based on 70% of your gross weekly income before the accident, subject to the maximum amounts.
- Under the standard accident benefits limits, the maximum weekly amount payable for the first 2 years following the accident in Ontario is $400 per week
- No income replacement benefits are payable in the first 7 days following an Ontario accident
- Optional accident benefits limits increase the maximum weekly amount to $600, $800 or $1,000 per week
How to apply for income replacement benefits…
In order to receive income replacement benefits, Ontario accident victims need to submit a completed
- OCF-10 Election of Income Replacement, Non-Earner or Caregiver Benefit
- OCF-3 Disability Certificate
- OCF-2 Employer’s Confirmation
If you have been involved in an Ontario car accident and are unable to work, you most likely qualify for income replacement benefits. It is important that before you fill out the associated accident benefits forms that you contact an experienced Ontario personal injury lawyer . The best Ontario personal injury lawyers not only will help you fill out these forms, they will ensure that it is done in a manner that gets you maximum benefits support.
The Ottawa Injury Blog is written regularly by Ottawa Ontario injury lawyer David Hollingsworth. Since 1999, David has been an Ontario personal injury lawyer representing Ontario accident victims who have suffered a personal injury and the families of accident victims who have lost a loved one in an Ontario accident. This blog reports on accidents in eastern Ontario, personal injury issues, local Ottawa news and events and various news that relates to Ottawa, accidents and personal injury. Visit www.ottawainjury.ca for more information. If you have a question, feel free to call or email [email protected] (613) 978-9549
Ontario Personal Injury Lawyer David Hollingsworth, Income Replacement Benefits, Ontario Accident Benefits
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.