WHAT DO ACCIDENT BENEFITS INCLUDE?

Medical and Rehabilitation Benefits

 

This benefit covers health care and rehabilitation costs due to the accident. Benefits include physiotherapy, prescriptions, chiropractic treatment, counseling, workplace, and home modifications, and other services that are not covered by the Ontario Health Insurance Plan (OHIP) or through your employee benefits plan*. Eligible medical care and costs are listed in the Statutory Accident Benefits Schedule. *If you have coverage under an employee benefits plan, you must submit your claim to your employee benefits plan first. Any eligible unpaid amount can be covered by your auto policy, subject to certain limits and maximum rates for treatment.

 

Attendant Care

 

This benefit covers the cost of an attendant if you need one to care for you, either at home or in a health-care facility. An aide or attendant can help with bathing, dressing, toileting, etc. This benefit is included if you’ve been seriously injured in an auto accident. The coverage for Medical, Rehabilitation, and Attendant Care is limited to $65,000 for non-catastrophic injuries and $1,000,000 for catastrophic injuries.

Income Replacement

If you are unable to work due to the accident and you suffer a loss of income, you may qualify for income replacement benefits up to 70 per cent of your gross income (a maximum of $400 per week), unless you had increased your coverage up to $1,000 per week. If you have other income replacement assistance available (e.g. sick leave or a disability plan from an employer), your benefit will be reduced per the amounts  received.

Non-earner Benefit

If you don’t qualify for income replacement, are a student, and cannot continue any or all of the activities you used to do before the accident, you may qualify to receive non-earner benefits of $185 per week. There is a four-week waiting period for this coverage.

Caregiver Benefit

If you can no longer provide care to a family member/dependant residing with you (child or other) as a result of a catastrophic injury, you may be eligible for the caregiver benefit. These benefits reimburse you for expenses associated with hiring someone to provide care while you are not able to do so. The caregiver benefit includes:

• Up to $250 per week for the first family member
• An additional $50 per week for each additional family member in the household

Standard accident benefits coverage only provides this benefit for those suffering catastrophic injuries; unless you had increased your coverage to get this benefit for all injuries.

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Additional expenses may also be covered as a part of your accident benefits coverage. They include:

Lost Education Expenses

This benefit provides compensation for lost tuition, books, and other education-related expenses up to $15,000, for those who cannot continue their studies as a result of injuries from an auto accident. 

Expenses of Visitors

This benefit provides compensation for reasonable and necessary expenses incurred by your immediate family members while visiting you during your treatment or recovery. It includes your spouse, children, grandchildren, parents, grandparents, siblings, and certain other dependants and guardians. Expenses can be claimed for a maximum of 104 weeks after the accident unless injuries are catastrophic.

Housekeeping and Home Maintenance

This benefit provides $100 per week if you experience catastrophic injuries due to an auto accident and need to hire someone to carry out housekeeping or home maintenance responsibilities unless you had increased your coverage to get this benefit for all injuries.

Damage to Clothing, Glasses, and Other Belongings

This benefit will provide compensation for items worn at the time of the accident that were either lost or destroyed during the auto accident (e.g. clothing, glasses, hearing aids).

Cost of Examinations

This benefit provides compensation for the cost of approved examinations related to treatments as part of your recovery from an auto accident.

Supplementary Goods

This benefit provides products that help with your recovery (e.g. cervical pillow, pain relieving gel, back support).

Transportation Expenses

This benefit covers parking fees and mileage ($0.40/kilometer after the 50-kilometer deductible.

Optional Dependant Care Benefit

This benefit pays for additional childcare expenses due to injuries sustained from an auto accident. It provides coverage up to $75 a week for your first child and $25 for each additional child and can only be claimed if you were employed at the time of an accident. To be eligible for this benefit, you cannot receive the caregiver benefit.

Optional Indexation Benefit

This benefit provides an annual adjustment for inflation for certain accident benefits. Adjustments are done following the Consumer Price Index of Canada and apply to the following benefits:

• Income replacement benefit
• Non-earner benefit
• Attendant care benefit
• Medical and rehabilitation benefit

If you die as a result of a car accident, this benefit will provide a lump sum payout to your family members/dependants.
The standard accident benefits coverage includes a payout of:

• $25,000 to your spouse
• $10,000 to each of your dependants
• A maximum of $6,000 for funeral expenses

If you had increased your coverage for this benefit, then the payout is as follows:

• $50,000 to your spouse
• $20,000 to each of your dependants
• A maximum of $8,000 for funeral expenses