Injury Lawyers Since 1984

ACCIDENT BENEFITS LAWYER TORONTO

Boland Romaine are personal injury lawyers dedicated to helping accident victims across the GTA and Ontario with accident benefits claims. If you have been seriously hurt in a car accident, we encourage you to call our office today and arrange for a free consultation to discuss your rights and how we can help.
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What Are Accident Benefits?

Accident benefits may be claimed by every individual injured in an Ontario car accident from their own or a related auto insurance company, regardless of who is at fault for the collision. For this reason, accident benefits are sometimes referred to as “no-fault benefits.”
All Ontario auto insurance companies provide accident benefits to policyholders and accident benefits coverage is mandatory on all automobile insurance policies. Insurance companies such as Intact, BelAir Direct, Aviva, RBC, TD, Desjardins, the Co-operators, Travelers, Allstate, and Economical all provide accident benefits coverage.

Below is a summary of the types of benefits available under standard accident benefits:

How Can We Help?

As car accident lawyers, Boland Romaine LLP has handled accident benefits claims for 40 years. Since then, we have assisted thousands of clients across the GTA find the right rehabilitation support teams they need to formulate treatment plans and guide recovery. We have established strong working relationships with case managers, physiotherapists, occupational therapists, rehabilitation support workers, neuropsychologists, and cognitive and behavioural therapists across York Region and Ontario that are trained in accident benefits.

We have recovered compensation for individuals who have suffered:

  • traumatic brain injuries
  • post concussive injuries
  • spinal cord injuries
  • spinal fracture injuries
  • fatal injuries
  • burn injuries
  • polytraumatic injuries
  • orthopedic injuries
  • joint ligament injuries
  • chronic pain
  • psychiatric/psychological injuries, including posttraumatic stress disorders, adjustment disorders, major depressive disorders
  • scarring/disfiguring injuries
  • amputation injuries
  • neurological injuries

Boland Romaine understands that you have suffered serious injuries and that it is important that you enjoy the best possible recovery. Our main role is to help you navigate the accident benefits scheme, advocate on your behalf, and help secure the funding and resources you need to recover and obtain ongoing benefits for support.

We will fight to protect you and your future. By way of example, we help you secure income replacement benefits in the event your injuries prevent you from working, or housekeeping and home maintenance benefits if your injuries prevent you from maintaining your home

Can I Claim Accident Benefits If I Don’t Have Auto Insurance?

Yes. The Ontario law applicable to accident benefits is designed to provide some level of accident benefits to all individuals injured in a motor vehicle accident; even if you do not have your own auto insurance policy.

If you were the driver or a passenger of car or motorcycle owned by another person, or were a pedestrian or cyclist struck by another driver, you can claim accident benefits from the vehicle owner’s auto insurance company. If the owner of the vehicle was uninsured, you can claim accident benefits from the auto insurance company of another vehicle involved in your accident, or, in cases of last resort, the Ontario Motor Vehicle Accident Claims Fund.

If you were the driver of your own motor vehicle and did not carry auto insurance, you are unable to claim income replacement benefits, non-earner benefits, among other benefits, however, may still claim benefits you need for medical treatment and rehabilitation.

How Do I Claim Accident Benefits?

You should inform your auto insurance company about your car accident within seven days. After learning of your car accident, your auto insurance company will send you a benefits package with forms you need to submit. This package will include:

· Application for Accident Benefits (OCF-1): The OCF-1 is your initial application for accident benefits. It will ask you to provide some essential information of your claim: your name, date of birth, date of the accident, employment, initial injuries, etc. You must complete and return your OCF-1 within thirty days of receiving the form. Your claim may be affected by any late submissions, which is why we encourage you to contact us soon after your motor vehicle accident.

· Disability Certificate (OCF-3): the OCF-3 is a form to be completed by your family doctor or treating healthcare practitioner that addresses any disabilities or impairments following your car accident. It must be submitted in order to claim income replacement benefits, non-earner benefits, caregiver benefits, and/or housekeeping and home maintenance benefits. It is important that you provide an OCF-3 to your family doctor and all your treatment providers as early as possible. The OCF-3 is an essential element of such claims, and your auto insurance company is not obligated to pay any disability benefits until after it is submitted. A more detailed overview of the benefits you can claim on the OCF-3 is provided below.

What Accident Benefits Can I Claim?

Depending on your accident benefits coverage and the severity of your injuries, you may have access to funds for medical treatment, attendant care, income replacement benefits, non-earner benefits, caregiver benefits, and housekeeping and home maintenance benefits, among other benefits described below.
The amounts and types of benefits you may claim depends on the severity of your injuries. The accident benefit scheme organizes injuries into three broad categories:

Minor Injury
Non-catastrophic injuries
Catastrophic impairments

The naming of each category is based on insurance industry convention. The amounts you can claim under each category of injury are set out in the Statutory Accident Benefits Schedule (“SABS”) and the terms of the standard Ontario automobile insurance policy, called the Ontario Automobile Policy – (OAP 1) Owner’s Policy. Those who purchase “optional benefits” may be entitled to claim additional benefits above the default accident benefits provided in the standard OAP 1.

Do I Have Optional Benefits?

Optional benefits may be purchased for additional premiums at the time an individual purchases an auto insurance policy. Your certificate of automobile insurance will indicate whether optional benefits were purchased on the policy and whether they are available to you.

Depending on which optional accident benefits were purchased, those individuals with optional benefits may be eligible to claim medical and rehabilitation benefits, attendant care benefits, income replacement benefits, non-earner benefits, caregiver benefits, or housekeeping and home maintenance benefits for longer periods of time or for greater amounts or increased policy limits.

You shouldn’t worry if your policy does not include optional benefits. The vast majority of Ontario drivers do not have optional benefits. In these cases, injured persons are still eligible to claim the benefits described below.

What Are Medical And Rehabilitation Benefits?

Medical and rehabilitation benefits generally refer to those forms of physical or psychological treatment you may claim from your auto insurance company. Common examples of treatment covered by accident benefits include chiropractic, physiotherapy, massage, or psychological counselling.

However, there are other types of rehabilitation benefits available to those seriously injured individuals, including life skills training, family counselling, social rehabilitation counselling, financial counselling, employment counselling, workplace modifications or devices, home modifications or devices, vehicle modifications or devices, transportation to treatment, as well as assistive devices to improve functionality.

Unless you have suffered a “catastrophic impairment” or purchased optional benefits, your auto insurance company will only pay for medical and rehabilitation benefits for up to five years after your motor vehicle accident.

How much medical and rehabilitation benefits can I access?

The amount of funds available to you depends on into which of the three categories mentioned above your injuries fall.

If you suffer a “minor injury,” your auto insurance company will fund a maximum of $3,500 for medical and rehabilitation benefits pursuant to a treatment protocol called the Minor Injury Guideline. A “minor injury” means “one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury.”

If you are found to suffer an injury that falls outside of the Minor Injury Guideline, you may claim a combined total of $65,000 for medical and rehabilitation benefits and attendant care benefits. See below for a description of attendant care benefits.

If you suffer injuries that render you “catastrophically impaired” under the accident benefit legislation, you may claim up to a combined $1,000,000 for medical and rehabilitation benefits and attendant care benefits. See below for a description of catastrophic impairments.

It is important to note that your auto insurance company is not obligated to fund treatment up to the maximum policy limits, and may deny proposed treatment even if your policy limits are not exhausted. In other words, being eligible to claim $65,000 or $1,000,000 in medical and rehabilitation benefits does not automatically mean your auto insurance company will fund treatment up to that amount.

How do I claim medical and rehabilitation benefits?

Requests for treatment are submitted directly to your auto insurance company by your treatment provider (i.e. physiotherapist, psychologist, occupational therapist) via a treatment plan called an OCF-18. Your treatment provider will prepare the treatment plan (or OCF-18) after consulting with you. The OCF-18 will list the name of the provider, their diagnoses, the goals of the treatment plan, the types of the treatment recommended, and the total cost of that treatment.

How will my auto insurance company pay for medical and rehabilitation benefits?

Your auto insurance company will review the treatment plans submitted by your treatment providers and make decisions whether the proposed treatment is “reasonable and necessary.” What is “reasonable and necessary” is a legal question informed by medical science that is initially decided by your auto insurance company, and, if you dispute their decision, an adjudicator following a legal hearing. As mentioned above, your auto insurance company may deny treatment plans even if your treatment provider believes that the treatment will benefit you.

If your auto insurance company approves the treatment plan, you can begin treatment as soon as it is available. Your healthcare practitioner will send their bills directly to your auto insurance company and be reimbursed. In most cases, you will not have to directly pay for any treatment that has been approved by your auto insurance company.

For those with private health plans that cover medical treatment, your auto insurance company may ask that your treatment provider submit their bills to your private benefits plan first. This is because the Statutory Accident Benefits Schedule only obligates your auto insurance company fund medical and rehabilitation benefits that are not otherwise already covered by private benefits plans.

If your auto insurance company denies the treatment plan, we may dispute their denial either by negotiating a resolution or commencing formal proceedings at the Licence Appeal Tribunal. Further details about the Licence Appeal Tribunal are set out below.

What Are Attendant Care Benefits

Attendant care benefits are a type of accident benefits relating to costs you incur to receive assistance with personal care from a personal support worker, rehabilitation support worker, friend, or family member. You cannot claim any attendant care benefits if you are being treated within the Minor Injury Guideline.

Unless you have suffered a “catastrophic impairment” or purchased optional benefits, your insurance company will only pay for attendant care benefits for up to five years after your accident.

How do I claim attendant care benefits?

You must first be assessed by an occupational therapist. The occupational therapist will come to your home, ask you to complete certain tasks, and make notes about your functionality. Based on their assessment, the occupational therapist will complete an Assessment of Attendant Care Needs (Form-1), which calculates each of your needs on an hours per week basis, and submit that to your auto insurance company.

Your auto insurance company may either agree with the Form-1 or request that another occupational therapist complete an assessment of your attendant care needs.

How much attendant care benefits can I claim?

The amount of attendant care benefits you can claim from your auto insurance company is equal to the amount set out in the Form-1 approved by your auto insurance company.

If you are found to have suffered a “catastrophic impairment,” you are eligible to claim a maximum of $6,000 per month in attendant care from your total combined $1,000,000 limits for medical and rehabilitation benefits and attendant care benefits.

If you do not suffer a “catastrophic impairment”, you are eligible to claim a maximum of $3,000 per month in attendant care benefits from your total combined $65,000 limits for medical and rehabilitation benefits and attendant care benefits.

Those individuals with optional benefits may be entitled to claim attendant care benefits in excess of the amounts above. It is important you review a copy of your automobile insurance policy or certificate of insurance to learn whether you have optional benefits available to you.

How will my auto insurance company pay for attendant care benefits?

Although your Form-1 sets out how much attendant care benefits you may claim, your auto insurance company only pays for those attendant care benefits you have already used. If you receive less attendant care than approved in the Form-1 on a given month, your auto insurance company will only pay the amount you actually spent.

To seek reimbursement for attendant care expenses, you must complete an Expenses Claim Form (OCF-6) and submit it to your auto insurance company. You will need to include copies of all receipts claimed in your OCF-6. Upon receipt and approval, your auto insurance company will release the funds to you as a reimbursement.

Who can provide attendant care benefits?

Any person can provide you attendant care benefits. While some clients receive attendant care directly from a personal support worker, others receive attendant care benefits from family members.

However, the role of the individual performing attendant care for you is a relevant factor for determining how the funds are calculated.

If your provider of attendant care does so in the course of their occupation (e.g. a PSW, rehabilitation support worker, a nurse, etc.), your auto insurance company will reimburse you for the amounts you pay to your attendant care provider after the fact. Attendant care received by hospital staff in hospital cannot be claimed under accident benefits.

Others may prefer to receive attendant care from family members. If attendant care provider is a friend or family member that does not normally provide attendant care as an occupation, your auto insurance company will compensate that individual only if he or she has suffered an economic loss, such as losing money or business revenue from having to take time off from their normal job to provide care. In this case, your friend or family member will need to provide proof of lost income, such as tax returns, pay stubs, or employment records.

What Is a “catastrophic Impairment”?

Being deemed catastrophically impaired by your auto insurance company makes you eligible to claim larger amounts of benefits over a longer period of time. For example, while medical and rehabilitation benefits are by default claimable up to $65,000 for five years after the accident, those catastrophically impaired individuals can claim up to $1,000,000 throughout their entire life. Further, certain benefits, such as caregiving benefits and housekeeping and home maintenance, are only available to those who are deemed to be catastrophically impaired.

There are several grounds under which you may qualify as having suffered a catastrophic impairment. These grounds are set up in the accident benefits regulations called the Statutory Accident Benefits Schedule (“SABS”). Depending on the nature of the injury and circumstances of the accident, some claimants are automatically deemed catastrophically impaired. Others must prove they meet one or more of the criteria.

Those not automatically deemed to be catastrophically impaired must have a physician submit an Application for Determination of Catastrophic Impairment (OCF-19) on their behalf. Your auto insurance company will review the OCF-19 in conjunction with your medical records and either agree you are catastrophically impaired or require that you be assessed by physicians and healthcare providers of its choice.

Income Replacement Benefits: What If I Cannot Return To Work?

Income replacement benefits are benefits paid weekly to those individuals whose injuries prevent them from returning to work.

To be eligible to receive income replacement benefits, you must suffer an impairment within 104 weeks (or two years) of the accident that results in a “substantial inability to perform the essential tasks” of your pre-accident employment. To meet this test, your auto insurance company will consider the essential tasks of your employment, the type of job you worked, and your typical hours, along with the nature of the physical or psychological restrictions you experience as a result of your injuries.

After 104 weeks (or two years) post-accident, the disability test becomes more stringent and your auto insurance company may stop paying your income replacement benefits unless you suffer a “complete inability to engage in any employment or self-employment for which you are reasonably suited by education, training, or experience.” To meet this test, your auto insurance company will consider your education and functional abilities to determine whether you can perform any occupation comparable to your pre-accident employment history.

How do I claim income replacement benefits?

You must have your doctor or a healthcare provider assess you and submit a Disability Certificate (OCF-3) to your auto insurance company on your behalf that indicates you meet the legal test to receive income replacement benefits.

Submitting the OCF-3 is essential to claiming income replacement benefits, as your auto insurance company does not generally owe you any income replacement benefits for the period before it receives your OCF-3.

To determine the amount of the weekly income replacement benefit you are owed, your auto insurance company may request employment and financial documents from you, including an Employer’s Confirmation Form (OCF-2) as discussed below.

Can I claim income replacement benefits if I am self-employed?

Yes. The process for self-employed individuals to claim income replacement benefits is similar to the process for those who are employed. A self-employed individual must prove they suffer an impairment that results in a “substantial inability to perform the essential tasks of his or her self-employment” within the first 104 weeks (or two years) after the accident, and then a “complete inability to engage in any employment or self-employment for which you are reasonably suited by education, training, or experience” after the post-104 week mark.

However, calculating the amount a self-employed person can receive in income replacement benefits often requires an accountant to review the business records and determine the person’s gross weekly self-employment income against their weekly loss from self-employment.

Can I claim income replacements if I was not working?

Even if you were not employed on the date of your accident, you are eligible to claim income replacement benefits if certain other circumstances are met. The SABS states that income replacement benefits are payable to those who were:

Employed for at least 26 weeks of the previous year or were receiving Employment Insurance;
16 years of age or older, or excused by law from attending school; and
Suffer a substantial inability to perform the essential tasks of the employment that the person spent most of the time during the 52 weeks before the accident.

How much income replacement benefits can I receive?

If you were employed at the time of the motor vehicle accident, your auto insurance company may pay you 70% of your gross pre-accident income up to a maximum of $400.00 per week. If you were self-employed, your auto insurance company will pay you 70% of the amount by which your gross weekly pre-accident self-employed income exceeds your gross weekly self-employed losses, up to a maximum of $400.00 per week.

Those individuals who have purchased optional benefits may be able to claim income replacement benefits exceeding beyond 70% of their gross weekly pre-accident income and above the maximum of $400.00 per week. On the other hand, those individuals who are over age 65 at the time they first become entitled to receive an income replacement benefit have the maximum $400 per week reduced by a multiplier set out in the SABS that is fixed based on the total number of weeks since you became entitled to income replacement benefits.

The amount of income replacements you may receive may be reduced if you are receiving long-term disability benefits or CPP disability benefits, or if you have been able to earn a reduced income from a partial or modified return to work.

To determine the exact weekly amount of income replacement benefits to which you are entitled, your auto insurance company may request your employment file, pay stubs, and tax returns, and ask your employer to complete an Employer’s Confirmation Form (OCF-2). Your personal injury lawyer will help you gather the information and records from your employer to confirm your income and assist you with receiving income replacement benefits.

What happens if I try to return to work?

You should always follow the advice of your family doctor and your treatment providers regarding any attempts to return to work. If your treatment providers encourage you, you feel you are able to attempt to return to work, and your employer can make any necessary accommodations, you should do so. The SABS stipulates that a claimant cannot lose their entitlement to claim income replacement benefits if they attempt to return to work within two years after the accident. However, the affect of a returning to work may result in a reduction to the amount of income replacement benefits you may receive each week.

Does income replacement benefits affect my long-term disability or CPP disability?

Whether or not you claim, receive, or are denied income replacement benefits has no direct effect on your ability to claim or receive long-term disability or CCP disability.

Income replacement benefits, long-term disability benefits, and CCP disability benefits are each subject to their own similar but distinct legal entitlement thresholds, meaning that failing to meet the disability test for one of the benefits does not automatically preclude you from meeting the disability test for one of the other benefits.

However, the amount of income replacement benefits you receive may be reduced by the amount of long-term disability or CPP disability you receive. The accident benefits scheme is set up such that your auto insurance company is able to subtract how much you receive in LTD or CPP from what it owes you.

While CPP disability and many long-term disability insurance benefits stop paying out once the person reaches age 65, income replacement benefits are automatically paid out until end of life to those individuals who continue to meet the disability test after their 65th birthday.

How long can I claim income replacement benefits?

There is no limit to how long you can receive income replacement benefits, so long as you continue to meet the disability test. During the first two-years after the accident, you can receive income replacement benefits if you suffer “a substantial inability to perform the essential tasks of your employment.” After two years post-accident, the disability test becomes more stringent and the analysis focuses on whether you suffer a “complete inability to engage in any employment or self-employment for which you are reasonably suited by education, training, or experience.”

During these times, your auto insurance company may deny your benefits upon receiving new medical information or after having you assessed or re-assessed by a doctor of their choice. If, however, you reach age 65 and are still receiving income replacement benefits, your auto insurance company is obligated to continue paying your weekly income replacement benefits for the remainder of your life with no ability to terminate benefits. However, these benefits are subject to a statutory “ramp down” formula that reduces to weekly amount payable.

On the other hand, those individuals who are 65 years or older at the time they first become entitled to income replacement benefits are only able to receive the benefit for a maximum of four years.

Non-earner Benefits: What If I Was Not Working?

Non-earner benefits are available to all those claimants who are either not entitled to receive income replacement benefits, or elect not to receive income replacement benefits. In most cases, non-earner benefits are claimed by those who were not working at the time of their accident.

Non-earner benefits are payable to those individuals who suffer “a complete inability to carry on a normal life.” The SABS defines a “complete inability to carry on a normal life” as “an impairment that continuously prevents the person from engaging in substantially all of the activities in which the person ordinarily engaged before the accident.” In this respect, the disability test for non-earner benefits is unique to that benefit and is considered differently than the test for income replacement benefits.

How do I claim non-earner benefits?

To claim non-earner benefits, either your doctor or a healthcare provider will first assess you and your level of functionality and then submit a Disability Certificate (OCF-3) to your auto insurance company on your behalf that indicates you meet the legal test.

Your auto insurance company is not required to pay you any non-earner benefits until one week after your car accident and only after it has received your OCF-3. Therefore, it is important you provide your family doctor or healthcare providers with an OCF-3 as early into your treatment as possible.

How do I show I suffer a complete inability to carry on a normal life?

Your auto insurance company is supposed to take a holistic approach of your pre-accident lifestyle, including which activities were most important in your life, and how frequently you performed them, and balance that against any impairments and restrictions that you have developed after your car accident.

In Heath v Economical, the Ontario Court of Appeal recognized the following factors to be considered when determining whether an injured person was entitled to receive non-earner benefits:

There must be a comparative analysis between the individual’s pre-accident and post-accident activities of daily living;
The assessment of the individual’s pre-accident activities of daily living considers their engagement over a “reasonable period of time” prior to the accident, rather than a snapshot of their immediate lifestyle at the time of the accident;
All of the individual’s pre-accident activities of daily living are to be considered, with greater weight placed on those the individual perceived to be most important;
The level of impairment must be continuous and uninterrupted;
An injured person does not “engage in” those post-accident activities if the degree of performance is “sufficiently restricted”; and
Returning to an activity with a high degree of pain amounts to being prevented from engaging in that activity.

How much non-earner benefits can I receive?

Non-earner benefits first become payable one week after the accident and are paid at $185.00 per week. Unlike income replacement benefits, your auto insurance company is not obligated to pay non-earner benefits after two-years post-accident and is not obligated to pay non-earner benefits to someone before that person is 18 years of age. Further, an individual that elects to receive caregiver benefits cannot claim non-earner benefits.

Caregiver Benefits: What If I Need Someone To Care For My Family?

A caregiver benefit is paid to those individuals who have suffered a “catastrophic impairment” and that suffer “a substantial inability to engage in the caregiving activities in which he or she was engaged at the time of the accident.”

To qualify for the caregiver benefit, you must live with and be the primary caregiver for another person who requires care. Common examples include children or family members with disabilities. However, you cannot recover caregiver benefits if you were being paid for the services you provided for the dependant prior to the accident. Further, you cannot receive caregiver benefits if you have elected to receive income replacement benefits or non-earner benefits.

Claiming the benefit involves having your family doctor or healthcare provider submit a Disability Certificate (OCF-3). If you qualify, you may receive $250.00 per week for the first person in need of care, and then an additional $50.00 per week for each additional person in need of care. After 104 weeks (or two years) after the accident, the entitlement requirements change and your auto insurance company may stop paying caregiver benefits unless you are found to suffer “a complete inability to carry on a normal life.”

Lost Educational Expenses: What If I Am A Student?

If you were a student attending elementary, secondary, post-secondary or continuing education, you may claim up to $15,000 in lost educational expenses if your injuries prevent you from either starting or attending a school program. The types of expenses for which you may receive reimbursement include tuition, books, equipment, room and board. You can only recover those expenses that have been incurred, meaning your auto insurance company will only reimburse you for the cost of goods you purchased or tuition you already paid, rather than goods or tuition you were planning to pay in the future.

To claim lost educational expenses, your family doctor or health care must submit a Disability Certificate (OCF-3) that indicates your injuries prevent you from returning to school. Your auto insurance company will also ask that you provide receipts or invoices that demonstrate what expenses you were charged and when they were paid.

Visitor Expenses: Can My Family Visit Me During My Recovery?

Your family members may seek reimbursement for those expenses incurred to visit you during your treatment or recovery. Reimbursement for such expenses is available to spouses, children, grandchildren, parents, grandparents, or siblings of the injured person, or someone that either lives with you or has demonstrated a settled intention to treat you as part of their family.

In such cases, these individuals may apply for reimbursement by submitting an Expenses Claim Form (OCF-6) to the same auto insurance company that is providing you benefits. Your auto insurance company will only pay those “reasonable and necessary” expenses that have been incurred within 104 weeks (or two weeks) of the date of the accident. If you have suffered a “catastrophic impairment,” your family members can claim reimbursement for visiting expenses after two-years post-accident, so long as those expenses continue to be “reasonable and necessary” and during your ongoing treatment or recovery.

Whether an expense is “reasonable and necessary” is a legal question that considers the type of expense claimed, the amount claimed for the expense, the frequency of the expenses, as well as the totality of the circumstances.

Housekeeping And Home Maintenance Benefits: What Will Happen To My Home?

You may be eligible for housekeeping and home maintenance benefits if you have suffered a “catastrophic impairment” or purchased optional benefits.

To claim housekeeping and home maintenance benefits, a doctor or healthcare provider must first assess you and submit a Disability Certificate (OCF-3) indicating that you suffer a “substantial inability to perform the housekeeping and home maintenance services that he or she normally performed before the accident.” Your auto insurance company may ask that you provide additional information about what types of housekeeping or chores you would do around your home before your car accident, and how frequently you would do them.

Payments for housekeeping and home maintenance benefits are capped at $100.00 per week. Much like attendant care benefits, your auto insurance company only reimburses those “reasonable and necessary” expenses you have already paid. This means you must first pay for housekeeping and home maintenance expenses before you can receive reimbursement.

Damage To Clothing, Glasses, Hearing Aids, Etc.

You may also claim reimbursement for any “reasonable” expenses you incur to repair or replace any clothing, prescription eyewear, dentures, hearing aids, prostheses and other medical or dental devices that were lost or damaged in your car accident. Submitting a claim involves producing an Expenses Claim Form (OCF-6) to your auto insurance company.

It is important that you keep receipts for any clothing or devices you purchase after your car accident, as your auto insurance company may ask for proof of when the items were purchased.

Death Benefits And Funeral Benefits

In the event that a family member is killed in a motor vehicle accident, you may claim death benefits and funeral benefits from your auto insurance company by submitting a Death and Funeral Benefits Application (OCF-4).

Death benefits are lump sum of money paid to family members of the deceased on compassionate grounds. However, there are applicable timelines that outline the coverage. The benefits are payable to family members of any insured period that dies as a result of their car accident within 180 days of the accident, or, within 156 weeks after the accident, if the insured period suffered a continuous disability as a result of their injuries.

The amount payable in death benefits depends on the relationship between the deceased and the claimant. Generally, spouses receive $25,000.00 and each dependent receives $10,000.00. In the event the deceased was not married, an $25,000.00 is distributed is divided and distributed to the deceased’s dependants.

Funeral benefits allow you to claim up to $6,000.00 in reimbursements for funeral expenses paid for the deceased’s funeral. Those who have purchased optional benefits may be entitled to received a higher amount for funeral expenses. It is important you keep all receipts of funeral purchases, as your auto insurance company may ask that you provide proof of the expenses paid.

Can Family Members Claim Accident Benefits Not Involved In The Accident?

Yes, family members and dependents can file claims for medical and rehabilitation benefits, among other benefits, even if they were not involved in the collision. It is not uncommon that parents, siblings, or children will endure psychological trauma after a family member is killed or suffers serious personal injury after a car accident. However, only those individuals involved in the car accident can seek to be deemed catastrophically impaired under the Statutory Accident Benefits Schedule.

Attending Insurer’s Examinations

Your auto insurance company may request you attend one or more medical examinations throughout your accident benefits claim. Your auto insurance company may justify these examinations by telling you they are required in order to determine whether your accident benefits remain payable or to determine whether new or continued treatment is “reasonable and necessary.”

These doctors will be hired by your insurance company to examine you based on their field of expertise and provide an opinion regarding whether you are entitled to claim a particular benefit. You are required to attend any medical examination requested by your auto insurance company, so long as the request for the exam is “reasonable and necessary.” Whether the examination is “reasonable and necessary” is a legal question.

What If My Auto Insurance Company Denies My Claim?

The Licence Appeal Tribunal (the “LAT”) is the administrative tribunal in Ontario that handles appeals of denials of accident benefits. Under Ontario law, you must appeal any denials made by your insurance company with two years of the denial. Failure to do so may result in losing entitlement to that benefit. Your personal injury lawyer will help you with preparing your application.

The LAT functions similar to court. After an application is filed, your auto insurance company will appoint a lawyer that will file a response on their behalf. The LAT will then schedule a case conference. Case conferences are conducted over the phone by an impartial adjudicator and provide an informal setting for the you, your auto insurance company, and the lawyers involved to try to resolve your accident benefits claim. You are required to attend the case conference. If your application or claim does not settle at the case conference, the case conference adjudicator will proceed to schedule a hearing at the LAT.

The length and mode of hearing at the LAT depends on the types of issues you appeal in your application. Some hearings may be conducted in-person or virtually and last one to two weeks. Some hearings are conducted entirely via written submissions prepared by the lawyers.

Can I Settle My Accident Benefits Claim?

You are able to settle your accident benefits claim with your auto insurance company, however you are not obligated to do so. Further, Ontario law prohibits any settlement of an accident benefits claim within one year of the accident.

It is important you consult with a personal injury lawyer before settling your accident benefits claim, as it may affect any rights of recovery you may have in an ongoing tort lawsuit against another driver involved in your motor vehicle accident. Ontario law permits the defendant in a tort motor vehicle accident lawsuit to reduce from their settlement or trial award some of the amounts you receive from settling your accident benefits claim. However, your auto insurance company is not able to deduct any amounts you receive in your tort lawsuit from your entitlement to accident benefits. Click here to learn more about whether you may have a motor vehicle accident tort claim.

How Soon After My Car Accident Should I Consult With A Lawyer?

It is advisable you contact an Ontario personal injury lawyer soon after your motor vehicle accident. A personal injury lawyer with knowledge of the SABS can help you navigate the accident benefits scheme, inform you of your rights, and challenge any denials from your auto insurance company.

What If I’m At Fault For The Car Accident?

You can still claim accident benefits from your auto insurance company even if you caused your motor vehicle accident. You can also claim accident benefits in single-vehicle accidents. With few exceptions, your ability to claim accident benefits is separate and apart from whether you are at fault for your car accident.

Can I Claim Compensation If I Was Impaired By Drugs Or Alcohol?

Yes. You can still claim some accident benefits if you were impaired by alcohol, cannabis, or other drugs. However, the Statutory Accident Benefits Schedule sets out that your auto insurance company is not obligated to pay certain benefits, such as income replacement benefits, non-earner benefits, or visitor expenses, if you were convicted a criminal offence, such as impaired driving, as a result of the motor vehicle accident. If you were an impaired passenger, cyclist, or pedestrian, the extent you were impaired by alcohol, cannabis, or drugs will not affect your rights to compensation under a claim for accident benefits, so long as you were not charged with a criminal offence as a result of the motor vehicle accident.

If I Retain A Lawyer, Do I Still Have To Deal With My Auto Insurance Company?

No. Your focus should be on your recovery. Although you will still receive letters and benefits statements from your auto insurance company that provide periodic updates or the insurance company’s decisions about funding new requests for treatment, a personal injury lawyer will deal with your adjuster on your behalf and help secure the funding you need.

Just as you have a healthcare team to assist you in getting better, Boland Romaine provides a legal team whose main priority is to ensure that you are fully compensated while at the same time eliminating the stress and aggravation caused by dealing with your insurance company. We will complete all necessary paperwork, apply for all benefits that you are entitled to, and take all steps to aggressively prosecute your claims.

What Are Legal Disbursements And How Do I Pay For Those?

Disbursements consist of money that our firm spends during the processing of your accident benefits claim. While your auto insurance company will generally pay the fees to obtain your medical file, hospital records, or employment files, there may additional costs of advancing a claim, such as fees for experts, and applications to the Licence Appeal Tribunal.

You do not have to pay for these disbursements. Boland Romaine will pay for all of these disbursements and only ask that we be reimbursed if there is a successful outcome with your case

Request a Free Consultation

You will not pay any fees until your case is won or settled.
Or Call 1-844-837-6583
WHY CHOOSE OUR TEAM OF INJURY LAWYERS

Personal Injury Lawyers With A

Trial Record and Reputation To Show For

We have successfully taken numerous cases to trial and in some changed the law to better protect and better compensate the public.
Our Personal Injury Lawyers have earned the respect of the insurance industry and settled numerous cases justly and fairly.

  • Real Trial

    Lawyers Since 1984

    The firm is specialized in personal injury law and is highly experienced in all types of injury matters including catastrophic injuries, wrongful deaths, serious motor vehicle accidents, slip and trip and fall accidents, occupier’s liability, defective products.

  • We Have The Resources To Fight The

    Insurance Companies In Your Corner

    We have spent upwards of $300,000 on a single file, developing the medical and engineering evidence needed to take complicated case to trial.

  • Servicing The

    Injured Across Ontario

    We routinely handle cases in Newmarket , Aurora and across Ontario as well as cases from out of province and the United States.

  • Lawyers Who Are

    Dedicated To Our Profession

    We have dedicated our professional careers to pursuing the highest standards of personal injury litigation. We are recognized by the Law Society of Ontario as Specialists. We are frequent speakers at conferences, educating our fellow personal injury lawyers.

  • You Do Not Pay Any Legal Fees Unless

    We Successfully Resolve Your Claim

    Our retainer is based on a contingency fee meaning that you do not pay any money upfront throughout our representation. We charge a flat fee upon successful settlement or judgment of your claim. We are upfront about all fees and expenses and ensure that.

  • We Work To

    Reduce Your Risk

    We will assist you in obtaining adverse cost insurance to reduce or eliminate costs, fees and disbursements of an unsuccessful claim. With the overwhelming majority of cases resulting in a settlement this will provide a significant piece of mind.

Your  Future  Is Worth Fighting For

Choose a personal injury lawyer 

who will fight for you 

1-844-837-6583

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Boland & Romaine

4.9

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every single client.

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