Accident Benefits in Ontario: What They Cover

Car accidents are unfortunate events. While in most accidents people only sustain minor injuries and are back on their feet after simple treatments, others can be fatal, turning the lives of the parties involved upside down. Normal tasks can even become difficult to undertake without help. Other people may even need physical rehabilitation necessitating the need for financial help to accommodate the absence from their income-generating activities. Thankfully, car insurance in Ontario helps cater to such costs. In Ontario, accident benefits must be included in all auto insurance policies. 

What is accident benefits coverage?

This is mandatory coverage that caters to injuries sustained by any party in the event of an accident. It is part of every auto insurance policy in Ontario and provides coverage for the drivers, passengers, pedestrians and even the bystanders involved, regardless of who was at fault for an accident. For more details about this, feel free to also read our post about mandatory insurance in Canada. 

What coverage is provided in accident benefits? 

1. Medical and rehabilitation benefits

This provides coverage for medical and rehabilitation benefits that are not covered by the Ontario Health Insurance Plan, private healthcare insurance or an employer. These benefits cater for costs incurred in the course of treatment such as dental care, ambulance & hospitalization, mobility devices, occupational & psychological therapy, chiropractic care, surgery, physiotherapy and family counselling. Medical and rehabilitation benefits have a $65,000 limit for non-catastrophic injuries and a $1,000,000 limit for catastrophic injuries. 

However, these limits can be increased by purchasing coverage of $130,000 for non-catastrophic injuries and $2,000,000 for catastrophic injuries. For an even higher tier medical and rehabilitation coverage, consider purchasing $1,000,000 for non-catastrophic injuries coverage and $2,000,000 for catastrophic injury coverage. 

2. Income replacement benefit

This caters to lost income due to injuries sustained in an accident. Affected persons are paid the lesser between $400 per week or 70% of the net income. While it does not provide coverage for the total lost income, it is a great step to ensuring affected persons have the basic needs. Higher coverage options are also available. You can opt for coverages that have higher weekly payments of either $600, $800 or $1,000 weekly. 

3. Non-earner benefits

If you were not earning any income before the accident, you get $185 weekly less other income replacement assistance provided during that period. In Ontario, non-earner benefits can be claimed by: 

• Persons who cannot look after themselves and do not qualify for an income replacement benefit 104 weeks after an accident. 

• Accident victims who cannot carry out a normal life within 104 weeks after the accident. This also applies to persons who are enrolled in full-time education or who completed education one year before the accident or those who are self-employed. 

4. Caregiver benefit

This accident benefit offers compensation for the accident victim if he or she is the primary caregiver in the family and is unable to do so. The benefit compensates costs that may be incurred in hiring another person to cater for the dependents and is common in single-parent families or one-stay-at-home families. 

The caregiver benefits include up to $250 weekly for looking after the first dependent and $50 weekly for every subsequent dependent in the family. Under the standard accident benefits coverage, only catastrophic injuries are covered for the caregiver benefit. However, there are optional add-ons for non-catastrophic injuries. 

5. Death and funeral benefit

The death benefit provides a lump sum payout to the dependents or a spouse if an accident victim passes away due to an accident. The benefit also caters to some funeral expenses within 180 days of the accident. This benefit entitles the victim’s spouses to $25,000, $10,000 to each dependent, a $6,000 funeral benefit and $10,000 to former spouses in instances where the deceased had financial obligations to them. 

Bonus — Click here to learn about buying a used car with accident history. 

What other accident benefits do the Ontario accident benefit provide coverage for?

• Damage to medical devices and clothing- An insurer should cater for the replacement of clothing that an accident victim was wearing at the time of the accident. Similarly, medical devices such as dentures, hearing aids, prescription eyewear and lost or damaged medical devices should be compensated. 

• Lost educational expenses- Coverage is provided for students who cannot continue with education due to injuries sustained in an accident. The coverage provides for educational materials such as books & materials, tuition as well as other educational-related materials to a maximum of $15,000 annually. 

• Cost of examinations- The insurer should cater for the cost of medical examinations when a patient is recovering from an accident. 

• Housekeeping- Catastrophic injuries necessitate the need for extra help to run a home, which is often hired. This can be claimed from your insurer up to $100 weekly. The option can also be extended to cater to non-catastrophic injuries. 

• Visitors’ expenses- Accident victims can claim for expenses incurred by persons who lived with them or their family for a maximum of two years. This, however, does not apply to catastrophic injuries. 

Here are some other things that you should know about accident benefits in Ontario

• Accident benefits coverage is mandatory. If you do not have an Accidents Benefits policy or you have been missing payments, you risk paying fines ranging between $400- $50,000. You could even lose your license or be regarded as a high-risk driver and end up remitting higher premiums.

• If you are not insured and are involved in an accident, you have to cater for all personal injuries out of pocket. And if at fault, you have to cater for other people’s physical recovery too. 

• You must inform your insurer within 7 days after an accident for rehabilitation, medical and wage loss benefits.

• Your medical coverage through a private plan or work may pay for accident benefits before your auto insurance.

• Your benefits entitlement will only be determined by the date of your auto accident. The benefits applicable will remain unchanged even if the Statutory Accident Benefits Schedule changes. 

• Your right to claim for accident benefits may be affected if you were driving for work even in instances where you were using your car.

• For injuries that fall under the Minor Injury Guidelines, the maximum payable amount towards rehabilitation and medical expenses is $3,500. 

• If the amount compensated by your insurer is insufficient, you can apply for a review with the License Appeal Tribunal.