People in car accidents can find their routines turned upside down for a while. Most people will get back into the swing of things with a few days or weeks of physical rehabilitation. But those dealing with major injuries may need to reshuffle their short-term finances to accommodate treatment or a leave of absence from work. Car insurance helps to cover those costs, thankfully.
Ontario’s legislation mandates that accident benefits are included in all auto insurance policies. This helps to pay the bills for injured people to recover. This is one of the mechanisms that insures legally licensed drivers have a reasonable amount of coverage that they can expect to receive in a timely manner after an accident, along with the no-fault insurance mechanism that Ontario uses.
Explaining the accident benefit schedule
The statutory accident benefits schedule is a part of every Ontario auto policy. It is mandatory coverage that kicks in whenever someone is injured in an accident that involves a vehicle. The coverage applies to a surprisingly wide range of people, including:
- The drivers
- Passengers in all vehicles involved
- Bystanders and pedestrians involved
The coverage applies regardless of fault, too. That’s how car insurance works in Ontario. Statutory accident benefits insurance helps accident victims in a number of ways, and we’ve listed them here to help you understand how it all works.
Breaking down accident benefits in Ontario
Attendant care benefit
If you are unable to care for yourself without assistance (bathing, toileting, dressing, or feeding yourself) as a result of your injuries, then this personal accident benefit will pay reasonable and necessary expenses for an aide, attendant or long-term care facility.
The cost of these services is included in the medical and rehabilitation limit (above), which pays a maximum of $65,000 in benefits in total.
Medical and rehabilitation benefit
This benefit will pay for medical and rehabilitation expenses that aren’t covered by a government or private health plan.
There are various limits and controls on access to this benefit to keep in mind. This coverage is limited to $65,000 for non-catastrophic injuries and $1,000,000 for catastrophic injuries.
You also have the option of purchasing coverage for:
- $130,000 in expenses for non-catastrophic injuries
- $2,000,000 in expenses for catastrophic injuries
There’s also an option to buy high-tier coverage, which provides:
- $1,000,000 in total costs for non-catastrophic injuries
- $2,000,000 in total costs for catastrophic injuries
If you are unable to continue as a primary caregiver to your family, this benefit will reimburse you for the costs of hiring someone to help. This benefit helps out single-parent families, families with one stay-at-home parent, or households with other types of dependents.
According to the Financial Services Commission of Ontario, the caregiver benefits includes:
- Up to $250 per week for looking after the household’s first dependent
- An additional $50 per week for each subsequent dependent in the household.
Standard accident benefit coverage only provides that payout for those suffering “catastrophic injuries,” but you can purchase additional coverage to get this benefit for non-catastrophic injuries, too, even if it’s experiencing a sore neck after a car accident.
Income replacement benefit
If you’re unable to work because of your injuries, this will compensate you for the loss of your income. The benefits pay the lesser of a maximum of 70% of your net income or $400.00 weekly (whichever you hit first).
Accident benefits income replacement may not cover your previous salary, but it may help until you get back on your feet. If it’s not enough to cover your costs, then you can buy additional coverage that provides higher weekly payments of:
- $600 per week
- $800 per week
- $1,000 per week
Death and funeral benefit
If you were to pass away as a result of a car accident, the death benefit provides a lump sum payout to your spouse and your dependents. The funeral benefit provides a lump sum payout to cover some of the costs associated with your funeral expenses within 180 days of the accident.
Insurers have until 156 weeks after the accident to pay out the policy if the person involved was continuously disabled because of it.
Typical policies pay out these accident benefits:
- $25,000 to the person’s spouse.
- $10,000 to each of the insurer person’s dependents.
- $10,000 to former spouses if the insured person had financial obligations to them.
- A funeral benefit of up to $6,000.
The benefit itself pays $185 per week minus all other income replacement assistance received during that time. The non-earner benefit lets insured people claim payment if they fall into one of these circumstances:
- They suffer the inability to look after themselves (or to “carry on a normal life” as the law is worded) while also not qualifying for an income replacement benefit within 104 weeks of the accident.
- They are no longer able to carry on a normal life because of the accident and within 104 weeks of it, plus:
- is enrolled in full-time education of any kind, or;
- completed education within a year before the accident was wasn’t employed (or self-employed).
Other expenses benefit
This benefit may pay for expenses such as:
- Lost educational expenses
- Costs for bringing family members to visit you in rehabilitation facilities
- Reasonable costs related to housekeeping or home maintenance
- Clothing lost or damaged in the accident
The key part to remember about this particular accident benefit is that it’s usually decided according to this question: have the injuries sustained from the accident prevented you from facilitating these things?
If the damage from the accident is the cause, then your policy is more likely to pay out for those miscellaneous benefits.
The limits found in the statutory accident benefits schedule are relatively low and may pose a burden for some households. Thankfully, you can purchase optional accident benefits in Ontario, which increase the maximum limits for your policy.
These are the most common optional benefits:
- Extra income replacement, raising the limit from $400 per week to $600, $800, or $1,000.
- Additional coverage for caregivers, housekeeping, and general home maintenance.
- Additional medical coverage covering up to $130,000 (plus sales tax).
- Catastrophic impairment coverage for up to $1,000,000.
- Top-tier medical coverage for up to $1,000,000 if the person did not sustain catastrophic impairment due the accident, but with coverage of up to $2,000,000 if the person did sustain catastrophic impairment due to the accident.
- Additional death and funeral benefits that raise the spousal payment to $50,000, raises dependents’ payments to $20,000; dependents will get $50,000 if no spousal payment was required, though.
- Optional dependent care benefit
If the insured person sustains impairment from the accident, was employed before the accident, and isn’t receiving a caregiver benefit, then additional dependent care benefits will pay out like this:
- Up to $75 per week to cover necessary costs of living for the first dependent.
- Up to an additional $25 per week for each additional dependent after the first.
Be careful here though, because there’s some fine print in the law that states. “No optional dependent care benefit is payable in respect of an expense incurred after the insured person dies.”
Optional indexation benefit
This allows you to adjust the amounts received for certain kinds of accident benefits according to the Consumer Price Index for Canada. That’s insurance-speak for “keeping up with inflation.” The automatic adjustment of the income replacement benefit, non-earner benefit, attendant care benefit or medical and rehabilitation benefit are then adjusted according to inflation as of January 1 of that year.
It’s a good idea to speak to your insurance advisor to discuss whether you should be purchasing additional coverage.
The statutory accident benefits schedule can help pay any additional expenses for someone who is injured in a car accident. They are automatically included in every Ontario auto policy and are relatively easy to access through your insurance provider, so don’t lay awake at night wondering about coverage.
We’ve just provided a brief overview of your accident benefits in Ontario, but we can’t stress enough just how important it is for you to understand what your individual limits are, and to make sure you have the coverage that’s right for you. Upon the renewal of your policy is a good time to do a complete review with your broker – but you don’t have to wait for that if you’re in the mood to get organized right now.