- May 27, 2021
- Posted by: azimi
- Category: Accident Related Awareness
Most common questions and their answers
- What are attendant care (“AC”) benefits?
Attendant care benefits cover the expenses of hiring an aide or attendant to help an insured person with their day-to-day functions after they have been injured in a MVA
An attendant care expense must be “reasonable” and “necessary” in order to be able to successfully claim a benefit for it (Statutory Accident Benefit Schedule or (SABS), s. 19(1))
- Who pays for attendant care benefits?
Your insurance company
- What are the types of injuries to which attendant care benefits pertain?
An injury must meet two requirements to qualify for attendant care benefits:
- It must not be a predominantly minor injury or Minor Injury Guideline (“MIG”) injury
- It must have caused an impairment that results in a “substantial inability” to engage in the insured person’s pre-accident personal care tasks
Note: see our blog post on med-rehab benefits for a discussion of the legal definition of a “minor injury” for these purposes
- What are some examples of attendant care?
- Maintain and clean prosthetics (i.e. an artificial body part)
- Maintain and clean orthotics (i.e. a brace)
- Cleaning bedsheets as a result of incontinence
- Supervisory care (such as transfer to and from a wheelchair)
- Assistance with coordinating or scheduling attendant care
- Performing catheterizations
- Positioning, emptying and cleaning draining systems
- Bowel care (such as administering enemas or suppositories)
- Tracheostomy care (changing and cleaning tubes inserted into a person’s windpipe to help them breathing)
- Ventilator care (changing and cleaning equipment)
- Assist with completing a prescribed exercise program
- Skin care (such as attending to wounds, eruptions, burns etc.)
- Administering medication or monitoring medication intake
- Other therapy such as transcutaneous electrical nerve stimulation and dorsal column stimulation
Note: Attendant care benefits are distinct from, and do not extend to, housekeeping benefits such as house-cleaning, home maintenance or cooking
- How do I advance a claim for attendant care benefits?
The amount of an attendant care benefit is determined on the basis of the insured person’s submitted Form 1 (“Assessment of Attendant Care Needs”) (, s. 19(2)). The Form 1 is completed by an occupational therapist or registered nurse
- When must the insurer pay the attendant care benefits?
Within 10 days of receipt of the Form 1 (, s. 42(6)), subject to the insurer’s right to demand an independent examination (or “IE”), aka a defense medical (s. 42(4)), after which the insurer may prepare its own Form 1, possibly providing for less benefits than the insured person claimed (s. 42(13)(b))
- Are all reasonable and necessary attendant care expenses eligible for the benefit?
No; in order to be eligible for an attendant care benefit, the expense must also have been “incurred” by the insured person. An expense is incurred if:
- the insured person received the goods or services to which the expense relates,
- the insured person has paid the expense, has promised to pay the expense or is otherwise legally obligated to pay the expense, and
- the person who provided the goods or services either
- did so in the course of his/her occupation or profession, or
- sustained an economic loss as a result of providing the goods or services to the insured person (SABS, definition of “incurred”)
This requirement was put into effect via the legislative amendments to the SABS in September, 2010. It has the practical effect of eliminating payment for most friends and family members who provide attendant care services, even though these are the people best positioned to provide such services and even though it involves work.
- If my son or daughter is a caregiving professional, can I claim attendant care benefits for care they provide me after I was injured in a MVA?
If your child is a social worker (such as a child and youth worker who works for a CAS), then probably not because these kinds of professionals usually do not have qualifications or experience for providing personal support services or healthcare aid – cf. Shawnoo v. Certes Direct Insurance Company,  O.J. No. 6213.
However, the following factors weigh in favor of a family member meeting the criteria of providing care “in the course of his/her occupation or profession”:
- if they were trained as a doctor, nurse or PSW
- if they work or are looking for work as a doctor, nurse or PSW
- if they have work experience providing care
- When might a family member, who provides care to the insured person following injury in a MVA, be considered to have sustained an economic loss as a result of providing the care?
It depends on the facts of each case, but some examples include:
- If a parent takes an unpaid leave of absence from work to care for a minor child who was rendered paraplegic – Henry v. Gore Mutual Ins. Co.,  O.J. No. 2928
- If a child sacrifices taking a job in order to provide care for their parent – Aidoo v. Security National Ins. Co.,  OFSCD No. 257
The court has defined “economic loss” as a “financial or pecuniary loss or sacrifice” – Simser v. Aviva Canada Inc.,  OFSCD No. 8
- 10.Are there limits to attendant care benefits and, if so, what are they?
- Except where the insured has optional attendant care benefits in their insurance policy, in which case those terms would apply, attendant care benefits are, if the MVA occurred on or after June 3, 2019, subject to a monthly limit of
- for non-minor injuries → $3,000 (s. 19(3)1)
- for catastrophic injuries → $6,000 (s. 19(3)1)
- If a service provider did not provide care in the course of his/her occupation or profession but did sustain an economic loss, the amount of the attendant care benefit payable in respect of the care is limited to the amount of the economic loss (s. 19(3)4)
- The total amount of med-rehab and attendant care benefits is, if the MVA occurred on or after June 3, 2019, limited to a maximum of
- for non-minor injuries → $65,000 (s. 18(3)(a))
- for catastrophic injuries → $1 million (s. 18(3)(b))
- Except where the insured has optional attendant care benefits in their insurance policy, in which case those terms would apply, the duration of attendant care benefits is limited to
- for non-minor injuries → five years from the date of the MVA if the insured was at least 18 YOA on the date of the MVA or until the insured reaches 28 YOA if they were less than 18 YOA at the date of the MVA (s. 20(1))
- for catastrophic injuries → over the course of the insured’s lifetime (s. 20(2))