- November 7, 2021
- Posted by: azimi
- Category: Case Commentary
Learn about some extra benefits available to be purchased at the time of entering into a policy
At the time of entering into an insurance contract, the insurance provider is obligated to give the consumer information about optional benefits. Optional benefits provide enhanced coverage. They can only be purchased in relation to an accident before the accident occurs.
The optional benefits, governed by s. 28 of the Statutory Accident Benefits Schedule (or “SABS”), a regulation made under the Insurance Act, R.S.O. 1990, c.I.8, are applicable only to:
- the named insured,
- the spouse of the named insured;
- the dependents of the named insured and of the named insured’s spouse; and
- the persons specified in the policy as drivers of the insured automobile.
- The optional benefit for the Income Replacement Benefit (or “IRB”)
This increases the maximum weekly amount of $400 under definition “B” of subsection 7(1) to $600, $800 or $1,000, as selected by the named insured under the policy.
- The optional Caregiver Benefit (or “CGB”) Housekeeping and Home Maintenance Benefits (“HKB” and “HMB”)
The optional CGB is available if, as a result of and within 104 weeks of the accident, he/she is “substantially unable” to engage in the caregiving activities he/she was engaged at the time of the accident (and if the insured person was residing with the person in need of care, was the primary caregiver of the person in need of care and did not receive remuneration for engaging in caregiving activities) even if the impairment sustained by the insured person is not a catastrophic impairment. After 104 weeks after the accident, the test changes to “complete inability”.
The optional HKB or HMB is available if, as a result of the accident, the insured person is “substantially unable” to perform the housekeeping and home maintenance services that he/she normally performed before the accident, even if the impairment sustained by the insured person is not a catastrophic impairment. The HKB and HMB are not payable if more than 104 weeks has elapsed since the accident.
- Optional Medical-Rehabilitation (or “Med-Rehab”) and Attendant Care (or “ACBs”) Benefits
One optional benefit increases the maximum amount of med-rehab and ACBs from $65,000 plus any applicable HST to $130,000 plus any applicable HST for accidents that occurred after June 3, 2019 where the impairment is non- catastrophic and nonminor.
- Optional Funeral and Death Benefits
The optional death benefit increases the payment to the insured person’s spouse from the standard death benefit of $25,000 to $50,000; increases the payment to the insured person’s dependents from the standard death benefit of $10,000 each to $20,000 each; and (if the insured person had no spouse) increases the payment to the insured person’s dependents (other than a former spouse) from the standard death benefit of an extra $25,000 each to an extra $50,000 each.
The optional funeral benefit increases the maximum payment for funeral expenses from $6,000 to $8,000.
- Optional Dependent and Indexation Benefits
The optional dependent benefit is available if the insured person sustained an impairment as a result of the accident, was employed at the time of the accident, and is not receiving a CGB. The maximum amount of the benefit is $75 per week for the first dependent and $25 per week for each additional dependent up to a total of $150 per week. The benefit is no longer payable if the insured person dies.
The optional indexation benefit allows the weekly IRB amount, or yearly balance of med-rehab and ACBs, to be indexed for inflation; this enables applicable benefits to continue to provide the same level of financial assistance as the price of goods and services goes up over time.
 Zefferino v. Meloche Monnex Insurance Company, 2012 ONSC 154, paras. 22 and 23.
 SABS, sub-s. 28(3).
 SABS, sub-s. 28(2).
 SABS, para. 28(1)1.
 SABS, sub-para. 28(1)2.i.
 SABS, sub-para. 28(1)2.ii.
 SABS, para. 28(1)3.
 SABS, paras. 28(1)6.i.-iii. and paras. 26(2)1.-3.
 SABS, para. 28(1)6.iv. and para. 27(2)(a)
 SABS, sub-s. 29(1).
 SABS, sub-s. 29(2).
 SABS, sub-s. 29(3).
 SABS, s. 30.