Understanding your rights to accident benefits in Ontario

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The automobile insurance you carry as a driver in Ontario provides benefits in the event you are injured in a crash. The Statutory Accident Benefits Schedule, which is also referred to as the SABS, enables you to receive the medical care and treatment you need to recover from your injuries as well as other benefits, such as lost earnings. Changes to the Ontario Insurance Act in recent years could affect your rights to benefits, so it is important to understand how the SABS works.

What are your rights under the SABS after an accident?

The Statutory Accident Benefits Schedule pays benefits to anyone injured in a car accident without regard to who might have been at fault in causing the accident. Included among the benefits payable to someone injured in a collision are the following:

  • Medical treatment and rehabilitation for up to five years after an accident for injuries non-catastrophic injuries
  • Income replacement of up to 70% of earnings lost due to being unable to work up to a maximum of $400 a week.
  • Additional coverage is available to increase the weekly payment to as much as $1,000 a week.
  • Non-earner benefit for up to two years to individuals who were not working and earning an income at the time of the accident. Non-earner benefits cannot begin during the first four weeks after the accident.
  • The spouse of a victim killed in a car accident may receive a death benefit of $25,000 and other dependents receive $10,000. There is also a funeral benefit of up to $6,000.

Individuals suffering a catastrophic impairment as currently defined under the SABS may receive up to $250 a week as a caregiver benefit for one dependent and an additional $50 a week for each additional dependent. Housekeeping and home maintenance benefits of up to $100 a week are also available for individuals suffering a catastrophic impairment.

What is a catastrophic impairment?

The consequences of a serious physical injury suffered in an automobile accident could be severe enough to meet the SABS definition of catastrophic impairment making the accident victim eligible for benefits beyond what would otherwise be available. For instance, medical, rehabilitation and attendant care benefits available to someone suffering an injury that is non-catastrophic is capped at $65,000 unless the person had optional insurance coverage that could increase the cap to $130,000. The benefit cap for individuals with catastrophic impairment is $1 million unless the person purchased additional coverage raising the cap to a maximum of $2 million.

According to the definition contained in the Insurance Act, a catastrophic impairment based upon the presence of certain conditions, including:

  • Vision loss
  • Tetraplegia
  • Paraplegia
  • Traumatic brain injury
  • Amputation or severe ambulatory mobility impairment
  • Impairment of the whole person of at least 55%
  • Impairment of the whole person of at least 55% caused by a combination of physical and mental or behavioural impairments

The definition and the tests used to determine whether a person has a catastrophic impairment are complex. Anyone suffering serious physical injuries should consult with a personal injury lawyer familiar with the Statutory Accident Benefits Schedule who can provide legal advice and guidance.