You have been injured in a car accident and as a result you are not able to work or carry on your normal activities as before. There are important facts you need to know when applying for weekly benefits through your automobile insurance. This information sheet will help explain the Ontario laws concerning the payment of accident benefits to people injured in automobile accidents.

This includes:

  • people who have been employed
  • caregivers
  • those who have no income (non-earners).

There is not enough space in this document to deal with every detail of the laws covering statutory accident benefits and this should not rely upon legal advice. It does not contain all aspects of the auto insurance legislation. For the precise wording f the law, you should consult the Ontario Insurance Act and the Statutory Accident Benefits Schedule made under that Act.

If there is a disagreement about payments or what is considered a reasonable and necessary expense and it cannot be resolved, the Ontario Insurance Commission can be called in to help find a solution. To find out more about the OIC dispute resolution services, call 1-800-517-2332, or (416) 250-6714 Toronto).

You must tell your insurance company within 30 days of the accident, or as soon as possible, that you wish to apply for benefits. You must send your application for benefits within 30 days of receiving the application forms.

Income replacement benefit

This benefit is for people who have been employed prior to the accident. You may be eligible to get a payment every two weeks to partially replace the income you have lost if, within 2 years of an accident, you can no longer work at the same level or pace as before as a result of the accident.

You may qualify for benefit payments if you can answer “yes” to the following questions:

  • Did I suffer physical or psychological injuries within 2 years of an accident involving a motor vehicle and as a result, I am disabled from working?
  • As of the date of the accident,
  • Was I employed or self-employed?
  • Was I promised a job before the accident that was to begin within one year of the accident, which I can not start now?
  • Did I work for at least 26 weeks in the past 52 weeks before the accident?
  • Was I receiving Employment Insurance benefits?

How much do I get?

If eligible, you will receive a payment every two weeks of 80% of your net (take home) pay based on your income history before the accident, minus net income benefits payable from other sources such as your employer. The first seven days of your disability is not covered.

Your net (take home) pay is the total of your annual income minus Employment Insurance premiums, Canada Pension Plan payments and the income tax you would normally have deducted from your pay.

The amount you will receive will be calculated on the information you included on your application form. In general, benefits are calculated as follows:

  • for persons employed at the time of the accident, the income replacement is based on income earned in the 4 or 52 weeks before the accident;
  • self-employed people have their income replacement benefit based on income earned in the last 52 weeks or their last fiscal year completed before the accident;
  • for persons unemployed at the time of the accident, but receiving Employment Insurance benefits or those who had worked at least 26 weeks in the 52 weeks before the accident, the Income Replacement benefit is based on the income earned in the 52 weeks before the accident including Employment Insurance benefits;
  • if you become disabled after age 65, benefits are payable for up to four years on a declining basis. If you are receiving benefits and reach age 65, your benefit will be converted to a lifetime pension at a reduced rate.

If you have a contract to start work in the future, the income replacement benefit is based on the annual income of the employment you would have begun.

The maximum payment is $400 per week unless you have purchased higher benefits. Please call, a higher maximum is required.

The payments will begin within 14 days after you completed application is received by your insurance company. If your disability continues, a payment will follow at least every two weeks. If your application is questioned or refused, you will be given a written explanation immediately.

Caregiver benefits

A caregiver is someone who is responsible for looking after others. You may qualify for caregiver benefits under Ontario’s automobile insurance legislation, if you are an insured person who, as result of the car accident, is substantially unable t engage in the caregiving activities previously engaged in. The law also says that you must:

  • be living with a person in need of your care, and

be the primary or main caregiver and, at the same time, not be receiving any income for your caregiving activities.

How much do I get?

The caregiver benefit reimburses you for expenses aid out as a result of the accident in caring for our dependants. If eligible, you will receive $250 per week for the first person, and $50 per week for each additional person in your household for whom you were the main caregiver at the time you were injured.

As a caregiver, you may receive benefits for up to 04 weeks, during the period you are substantially unable to perform your caregiving activities. If you re completely unable to carry on normal activities, you may receive benefits after 104 weeks.

You may purchase optional caregiver and dependent care benefits that pay a higher benefit of 325 per week for the first person and $75 per week or each additional person. If this is required, please call the office immediately.

Non-earner benefits

You may qualify for non-earner benefits if you do not qualify for income replacement benefits, you no longer qualify for caregiver benefits, you were a full-time student, or you have completed your education in the past year but haven’t yet secured employment related to your education. To qualify or this benefit, you must suffer a complete inability o carry on your normal activities.

How much do I get?

You may be eligible to receive a weekly payment f $185 every two weeks. The first 26 weeks of our disability are not covered. If you were a student at the time of the accident and had been:

  1. enrolled on a full-time basis in elementary, secondary or post-secondary education at the time of the accident, or
  2. had completed your education less than one year before the accident and were not employed in a job that reflected your education and training, your benefits will increase to $320 per week after 104 weeks of disability.

You are not eligible to receive weekly benefits if you were:

  • driving without a valid license;
  • driving a vehicle when you knew or should have known you were driving without the owner’s consent;
  • a passenger who knew or should have known that the driver did not have the owner’s consent to drive the vehicle;
  • driving where you knew or should have known you were driving a vehicle without valid insurance;
  • convicted of a criminal offense arising out of the use of an automobile in connection with criminal activity;
  • convicted of impaired driving or refusing to provide a breath sample;
  • knowingly misrepresenting any important information when applying for auto insurance.

Disability certificate requirement

In order to receive income replacement, caregiver or non-earner benefits, you may require a certificate from a qualified medical person stating the cause and nature of your injuries with an estimate of how long your disability and treatment will last. Your insurer will pay for the cost of this certificate.

If you refuse treatment

Please note that your benefit can be reduced by 50% if you refuse to participate in rehabilitation o treatments that are reasonable or, in the case of the income replacement benefit, you are able and do not make a reasonable effort to return to work or t obtain other employment for which you are trained.

Where does the application go?

If you have your own automobile insurance or are covered under someone else’s policy, return the completed application to that insurance company; if you don’t have insurance, return the complete application to the insurer of the vehicle in which you were an occupant or which hit you if you were a pedestrian. If there is no insurance on that vehicle return the application to the insurer of any other vehicle involved in the accident and failing that call the Motor Vehicle Accident Claims Fund at 1 800-268-7188 or in the Toronto dialing area (416 250-1422).

Once payments begin, and if your eligibility continues, a payment will follow at least every two weeks after that. If your application is questioned o refused, you will be given a written explanation immediately.

Which benefit is right for me?

You may be eligible for more than one weekly benefit. If your application for benefits disclose that you qualify for more than one benefit, your insurance company will notify you. However, you must choose one only. Your choice may be between the weekly income replacement, caregiver, or non-earner benefits.

 

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