This is a common worry. Most people don't have the money to properly compensate someone they may have injured in a moment of carelessness — because they made a driving error, forgot to clear their front steps of ice and snow, or made some other mistake.
This is why we have insurance policies.
In almost every case, your injuries are not paid for by the person who injured you, but by their insurance company. This is what insurance companies are here for: so that nobody who is injured by someone else's mistake has to pay for their own injuries, and so that nobody has to go broke paying for their own mistake.
Accident benefits are designed to provide injured Ontarians with basic necessities in the event of injury, including income benefits for lost wages if you cannot work and payment of medical expenses.
Income Replacement Benefits (IRB):
Income replacement benefits are paid to individuals who cannot work as a result of their injuries.
- To qualify for IRB you must have been employed at the time of the accident, or on EI at the time of the accident or you must have worked at least 26 of the 52 weeks before the accident.
- The amount of your IRB is 70 percent of your average gross income using either the 4 weeks or the 52 weeks before the accident, whichever is higher.
- If you are self-employed, the amount of your IRB is based on 70 percent of your average gross income using either the 52 weeks before the accident or your last fiscal year.
- The maximum IRB payable is $400 per week unless you have paid for optional benefits to increase this amount.
- IRB are not payable for the first week after the accident.
- If you are unable to work and are receiving short term or long term disability benefits, these benefits are deductible from 70 percent of your average gross income. The difference, up to $400 per week, is payable as an IRB.
- IRB are potentially payable for life.
- For the first two years, they are paid if you are unable to do the essential tasks of your regular job.
- Beyond two years, they are payable if you are unable to do any employment for which you are reasonably suited by virtue of your education, training and experience.
- After the age of 65, the IRB is reduced based on an established formula and is payable for the rest of your life if you are unable to work.
Medical and Rehabilitation and Attendant Care Expenses:
You are entitled to payment of all reasonable and necessary medical and rehabilitation and attendant care (assistance with personal care and activities of daily living that you cannot perform) expenses.
- If your injuries are not “catastrophic” you are entitled to medical and rehabilitation and attendant care coverage for a maximum of 5 years, up to $65,000 if you do not have a “minor injury”.
- If your injury is deemed a “minor injury”, which usually includes whiplash injuries and sprain or strain injuries, you have up to $3,500 in medical and rehabilitation coverage and no attendant care coverage.
- Insurers will conclude early on that most claimants have a “minor injury”. Often times, these individuals experience long term pain and significant disability and do not belong within the “minor injury” classification. Only with the help of an experienced lawyer can this be successfully challenged.
- If you have suffered a catastrophic impairment” you are entitled to medical and rehabilitation and attendant care coverage for life, up to $1 Million.
Non Earner Benefits:
- If you do not qualify for an IRB, but are unable to do most of your regular previous activities you may be entitled to a non-earner benefit in the amount of $185 per week.
- The non-earner benefit begins 4 weeks after the accident and is only payable for a total of two years.
- Some severe injuries come within the definition of “catastrophic impairment” contained in the legislation that regulates automobile accident benefits. This gives rise to enhanced benefits.
- A determination of whether an individual has sustained a catastrophic impairment usually requires a thorough review of all available documents and, in some cases, the passage of time.
- If you have sustained a “catastrophic impairment” and at the time of the accident you were responsible for caring for a child or other person and after the accident you can no longer care for the child or other person you can claim a caregiver benefit to compensate you for the expense incurred to provide alternative care.
- The maximum payable is $250 per week for each person in need of care.
- This benefit is potentially payable for life if your disability is severe.