LAW RESOURCES & NEWS

What Are Accident Benefits?

If you are injured in an automobile accident, you will be eligible for something called accident benefits through you own auto insurance company – regardless of who is at fault for the accident!

Even if you don’t have your own auto insurance (not everyone drives), you will still be eligible for accident benefits through the insurance company of an automobile involved in the accident.  This may happen, for example, if you are a passenger in someone else’s car, you’re riding your bike or you’re a pedestrian and you’re hurt in a collision.

What then are accident benefits?

Well first off, the term “accident benefits” just means the insurance benefits that are potentially available to you if you are hurt in an auto collision. 

The main benefits that are part of the standard package are as follows:

  1. Income Replacement Benefits;
  2. Non-Earner Benefits;
  3. Caregiver Benefits;
  4. Attendant Care Benefits; and
  5. Medical Rehabilitation Benefits

If you were working at the time of your accident, or at least 26 of the 52 weeks before your accident, and you have difficulty returning to work, you may be eligible for income replacement benefits.  The test is actually more complicated than that and then it changes after two years!  But let’s try to keep things simple for the purposes of this blog. 

The maximum you can receive is $400 per week, which translates to $20,800 for the year – far below the average income in Canada.  The benefit will not make most people whole again, or anywhere close to whole again.

Moving to non-earner benefits, they are for people who have suffered a complete inability to carry on a normal life because of the accident.  The benefit is $185.00 per week, which translates to less than $10,000 for the year.

But what on earth is a complete inability to carry on a normal life?  It means that you are continuously prevented from engaging in substantially all the activities you ordinarily did before the collision.  That’s not much clearer of a definition, and lawyers and insurance companies often fight over the meaning of it (of course they do!).  But the point is this: even if you are not working at the time of the accident, you may be entitled to a weekly benefit if there has been a significant change to your ability to do your daily activities.

Now if you were the primary caregiver of someone living at your home and you are unable to provide that care because of your accident, you may be entitled to the caregiver benefit.  It is $250.00 per week for the first person in need of care and $50.00 per week for each additional person.

Unfortunately, you cannot receive an income replacement benefit, non-earner benefit and caregiver benefit at the same time – even if you qualify for all three!  You must choose one of those benefits only and the insurance company will send you (or is supposed to send you) an election form so you can make your choice.

There is also something called a medical / rehabilitation benefit and attendant care benefits.   They are separate benefits, but they share a maximum limit.  They are both available for five years for a combined total (for both together) of $65,000.

The attendant care benefits are to help people pay for an aide or attendant to help them with their personal care.  That would include, for example, helping an injured person with washing, dressing, administering medication and with their mobility.   The maximum you can receive is $3,000 per month.

Med / rehab benefits are for people who require dental or medical treatment, or to help people reintegrate into their family, the labor force or society more generally.  For instance, medical treatment may include physical therapy, chiropractic treatment, massage therapy or psychological counselling.  Rehabilitation may include employment counselling, assessing someone’s ability to work or modifications to someone’s home, workplace or vehicle to accommodate a disability.    

There is a caveat to everything I have outlined.  To make things even more complicated, people can be placed into different tiers depending on the severity of their injuries or the type of injuries they have suffered.  People may have “minor” injuries, catastrophic injuries or neither (in which case they are placed in the regular stream of benefits).  The tier you are in can affect what benefits are available, how long benefits are available or how much funding is available. 

To give you a few examples, if you have a “minor” injury, your med / rehab benefits are not $65,000 but a measly $3,500.  If you have a catastrophic injury, your med / rehab benefits are $1,000,000 (available for your lifetime rather than just 5 years) and your attendant care limit is $6,000/month instead of $3,000 per month.

There is also something called optional benefits that are not part of the standard package.  To find out more about what those add-ons may be, you will want to talk to your broker and get more details.  But you can add benefits, change how long benefits are available to you after an accident or your insurance limits. Often, it costs very little extra per month to make some very important changes or additions to your benefit package.

Our accident benefit system is very complicated – far more complicated than I have outlined here.  I have tried to keep things as simple and straight forward as I can. 

But if you take anything away from this blog, remember the following:

  1. You have insurance benefits available to you if you are involved in a car collision
  2. These benefits will be provided to you regardless of who’s at fault
  3. These benefits are available to you even if you don’t have auto insurance – as long an insured automobile was involved in the collision
  4. The benefits include funds to help you replace lost income, pay for treatment and rehabilitation, and perform your personal care routine, among other things
  5. Talk to your broker, talk to your broker, talk to your broker!  There are optional benefits you can select to tailor your benefit package to your lifestyle!

SHARE THIS ARTICLE

Share on facebook
Facebook
Share on twitter
Twitter
Share on email
Email

About the Author

JAMES PAGE

James Page was called to the Bar in 2010 and practices exclusively in the areas of personal injury and civil litigation.

James sits on the Board of Directors for the Halton County Law Association (HCLA) and is a Past President of the Brain Injury Association of Peel and Halton (BIAPH). He is also a member of the Ontario Trial Lawyers’ Association, the Hamilton Law Association, and is involved with the Ontario Justice Education Network (OJEN).