Motor Vehicle Accidents

If you are injured in a car crash, the physical and emotional consequences can be overwhelming. As you and your family try to get through a difficult time, insurance and legal issues can be overlooked. But there are certain actions you must take in order to get the benefits and compensation you need.

Your car insurance gives you two sets of rights and responsibilities. 

1. No-Fault Benefits (or Statutory Accident Benefits)

These are benefits paid by your own insurance company. You must tell your insurer about the car crash within seven days, and send back your Application for Accident Benefits within 30 days of receiving the forms. The application includes:

• An application form completed by you
• An employer’s confirmation of income
• A disability certificate completed by a doctor

The forms are hard to complete if you are unemployed or self-employed. If you work for yourself, you should consider hiring an accountant.

Statutory Accident Benefits are based on the coverage you have with your insurance company. Unless your claim for benefits is refused, this coverage usually entitles you to the following:

• Income replacement benefits

If you were employed when the car crash happened, these will be paid to you while you are off work. For the first two years you will be eligible to receive 80 per cent of your net wages, up to maximum of $400 a week. After two years, your auto insurance company may have to continue to pay these benefits if you are unable to do any job for which you are reasonably suited by training, eduation or experience (something very difficult to prove).

If you are unemployed, you may receive a non-earner benefit of $185 a week starting six months after the accident.

If you are self-employed, your insurance company will use a formula to determine your income replacement benefits.

• Caregiver benefits

These are paid at a rate of $250 a week for the first child or dependent and $50 for each additional child. You must be unable to take care of your children, and be paying someone else to do so, to be able to make a claim.

• Housekeeping (home maintenance) benefits
  

  If you can prove you need help with housekeeping and home maintenance, your insurance company will pay you as much as $100 a week for up to two years. You will only receive these benefits after two years if your injuries are deemed to be catastrophic.

• Attendant care benefits
  

  If you need someone to help you with personal care and hygiene, you can receive $3,000 a month for up to two years, to a maximum of $72,000.

If your injuries are deemed to be catastrophic, your attendant care benefit eligibility is $6,000 a month over your lifetime, to a maximum of $1,000,000.

• Medical and rehabilitation benefits

These are available to you for up to 10 years or up to $100,000, whichever comes first. They include medication, chiropractic care, physiotherapy, psychological treatment, rehabilitation aids and anything else that can help you recover. The insurance company will only pay for necessary items recommended by a healthcare provider.

If your injuries are deemed to be catastrophic, you could receive up to $1,000,000 over your lifetime.

• Other benefits

Death benefits, which pay $25,000 to the victim’s spouse, $10,000 to each of the victim’s children or dependants, $10,000 to the victim’s caregiver, and $6,000 for funeral expenses.

Expenses of family members who visit during treatment or recovery, including meals, mileage, travel and accommodation.

Lost education expenses for students, to a maximum of $15,000.

Additional coverage you may have purchased with your insurance.

• Refusal of Benefits - The Mediation Process

If your insurance company refuses to pay certain benefits or expenses, the next steps are to take your case to mediation.  You must apply to the Financial Services Commission of Ontario. A mediation must take place within 60 days of your application. Mediations are set up to help resolve disputes.

The mediator has no authority over either party, and everyone has to agree on any resolutions.

Very few disputes with insurance companies are settled at this stage, but mediation must take place before you can begin a lawsuit or arbitration against your insurer.

2. Benefits from the At-Fault Driver

If you decide to sue the driver you injured you, you must tell them in writing within 120 days. You also have to meet certain requirements for your case to be successful.

• You must prove that you have a serious and permanent impairment of an important bodily function which is physical, psychological or mental in nature.
• You also have to prove liability, that the other driver probably caused the car crash. The driver and their lawyer might say you are partly to blame for the accident, or that your injuries were caused by your failure to use your seatbelt.

I will fight to prove liability and get you the compensation you deserve. There are four types of compensation you may be entitled to:

• Pain and suffering and loss of quality of life (general damages)

This is a claim for your past, present and future difficulties. In Ontario, compensation ranges from $0 for a sprained thumb to $318,000 for someone who is brain-injured and quadriplegic.

It is also subject to a $30,000 deductible.

• Loss of care, guidance and companionship

This is for family members who have experienced a loss of care, guidance and companionship, or have lost money due to another family member’s injury. Compensation for every family member is subject to a $15,000 deductible.

Claims by family members are very low in Ontario because the compensation does not usually rise above the $15,000 deductible.

• Pecuniary damages (loss of wages)

This is a claim for loss of wages in the past, present and future, including any money not included in your income replacement benefits. If you return to work but make less money than you made before the car crash, you may have a claim against the at-fault driver. You may also have a claim in other situations.

• Out-of-pocket expenses and future care costs

This compensates you for any expenses not covered by your insurance company, including over-the-counter prescription medication or parking and mileage for doctors’ appointments. It does not usually amount to very much money.