Accident Benefits

Why it is important for claimants to be accurate in communicating about their injuries The owner or any occupant of a motor vehicle, or anyone present at a MVA, is not liable in an action in Ontario for damages for income loss, nonpecuniary loss and health care expenses unless, as a result of the use or operation of the automobile, the victim died or sustained a permanent serious disfigurement or a permanent serious impairment of an important physical, mental or psychological function.[1] The threshold issue is whether the plaintiff meets one of these exceptions. Analysis of whether an injury is…

Acquire knowledge of the highest category of accident benefits Often, in auto insurance cases, either the insured/injured person, their lawyer, a doctor or the insurer raises the issue of whether the injury is catastrophic. In Ontario, the maximum amount of accident benefits is provided for persons who are designated as having a catastrophic impairment. Types of impairments that qualify as catastrophic (or “CAT”) are specified in s. 3(1) of the SABS – subject to the qualifications, as applicable, in subsections (2) to (5) – and include impairments sustained as a result of an accident that occurred on or after June…

Learn about the elements of this cause of action Civil negligence – as opposed to criminal negligence, a crime – is a category of tort. A tort is a common law cause of action. Common law refers to the fact that Canada is part of the common law tradition. England developed its common law tradition over the past 1000 years, and tort law is a part of that tradition. The common law was received in all provinces other than Quebec. Cause of action refers to the fact that a tort is a civil wrong for which the law recognizes a…

Discover the procedure for Med-Rehab and AC applications Although we will consider qualification criteria in more detail in further blog posts, here we will consider the procedure for applying for accident benefits. Medical-rehabilitation (aka med-rehab) benefits The insured must apply for benefits under other policies first (e.g. short-term disability/long-term disability benefits, work insurance, etc.). The form used depends on whether the insured’s injury is catastrophic, non-catastrophic or minor. If the injury is either catastrophic or non-catastrophic, the “Treatment and Assistance Plan” (OCF-18) must be completed and submitted. If the injury is minor, the “Treatment Confirmation Form” (OCF-23) must be. These…

Acquire knowledge of examinations under oath and independent examinations In a claim for accident benefits, both the applicant and the insurer bear rights and obligations. These rights and duties have been balanced in order to make the process fair to each side. Fairness from the applicant’s perspective means getting benefits if they are entitled to them. Fairness from the insurer’s perspective means preventing the applicant from getting benefits if they are not entitled to them. Before examining the parties’ respective rights and obligations, let us first define some key terms. During an examination under oath (or EUO), the insurer’s legal…

Learn about the legal requirement that must be satisfied in order for someone to be able to apply for accident benefits and some recent cases where it has been applied Accident benefits are intended to facilitate immediate treatment and compensation after an accident. Liability is irrelevant. In most cases, the AB insurer is the injured person’s insurer. Unlike a tort claim, the injury does not have to be permanent and serious. The governing legislation is the Statutory Accident Benefits Schedule (or “SABS”), a regulation under the Insurance Act (or “IA”). In order to apply for accident benefits, one has to…

Collateral benefits are explained and it is shown how they can affect your tort and accident benefits claims Collateral benefits include private health benefits or disability insurance or benefits. Depending on the type of benefit, the defendant may be entitled to a setoff or deduction for the amount of the collateral benefit. Collateral Source Benefits Nature Function Deductibility CPP Disability Benefits Federal government program Monthly payments to supplement income for people who are unable to work because of their injury Whether the lawsuit is a tort claim or for accident benefits, the defendant is entitled to a setoff of these…

Discover the relationship between these two types of lawsuits A MVA file involves two lawsuits, a) the tort claim and b) the accident benefits claim. If a person is injured in a MVA (except on public transit vehicles), they are entitled to certain accident benefits regardless of whether or not they are at fault. There are strict timelines for accident benefits claims. First, it is necessary to claim from the accident benefits insurer before commencing a tort claim against the at-fault driver. Second, it is necessary to notify the accident benefits insurer of the intention to apply for accident benefits…