In Ontario, victims of car accidents are entitled to statutory accident benefits through their own insurer. Accident benefits range from income replacement and medical rehabilitation benefits to caregiver and housekeeping benefits. Importantly, accident benefits in Ontario operate on a ‘no fault’ basis. What this means is that accident victims are entitled to accident benefits regardless of whether they were at fault for the accident.
The adjuster (the representative of the company who handles the claim) assigned to an accident benefits file will determine whether to place the injured person in one of three categories: the Minor Injury Guideline, the ‘regular’ guideline, or catastrophic impairment. Medical records and insurer examinations are used to determine which of these three categories the injured person falls in.
If the accident victim’s injuries are determined to be catastrophic in nature, the sum of medical, rehabilitation and attendant care benefits the person is eligible to claim for and receive is $1,000,000, which are payable for a lifetime or until financial limits have been reached. Further, persons deemed to have suffered catastrophic injuries will most likely be deemed to have suffered a complete inability to perform their job duties because of their injuries, which qualifies them for income replacement benefits until retirement (and beyond at a reduced rate).
When a person is deemed to have suffered a catastrophic injury or injuries, insurers will keep note of the ‘burn rate’ with respect to medical, rehabilitation and attendant care benefits. If the victim has a high burn rate, as in, they require considerable treatment such as physiotherapy and massage, and attendant care services from a personal support worker, the insurer is incentivized to settle the claim by offering a settlement in lieu of continued benefits payments.
In the civil context (when an accident victim sues an at-fault driver), to recover non- pecuniary losses (i.e., non-monetary damages) and health care expenses, the accident victim must have suffered a permanent serious disfigurement or a permanent serious impairment of an important physical, mental or psychological function. This is known as the ‘threshold test’, which is laid out in the Insurance Act. A person who sustained a catastrophic injury would more than likely meet the test.
Further, it should also be noted that there is a $46,053.20 deductible which applies to any award for pain and suffering, where such award does not exceed $147,889.59. This deductible increases each year in accordance with the rate of inflation. Accident victims who are deemed to be catastrophically impaired are likely to meet/exceed the $147,889.59 in pain and suffering damages, which means the deductible would not apply to them.
There are different ‘criteria’ (a total of 8) under the Statutory Accident Benefits Schedule, which victims can apply under, all of which involve a severe injury or injuries that result in marked permanent functional impairment. They include but are not limited to loss of vision in both eyes, paraplegia, amputation of an arm, traumatic brain injury, severe physical impairments, a combination of mental and physical impairments, and severe mental impairments.
If you’ve been injured in a car accident in Ontario, you don’t have to face this challenge alone. Our Ontario injury law team is here to help. Please contact our office at 416-HURT911 (487-8911) or fill out our online form which is secure and confidential. You will be given a free assessment at no charge to you (and with no obligation to hire us).