Statutory Accident Benefits Insurance Quotes in Canada

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What is statutory accident benefit auto insurance?

Statutory accident benefit insurance is a mandatory form of no-fault insurance that provides certain accident benefits to anyone injured in an auto accident, regardless of who is at fault. It covers the driver, passengers, motorcyclists, pedestrians and other individuals to help pay for medical, rehabilitation and attendant care expenses who might be injured by an insured motor vehicle.

What does statutory accident benefits cover?

The Statutory Accident Benefits Schedule (SABS) is a mandatory endorsement all Ontario auto insurance providers must offer, and this outlines what is covered under your policy.

It outlines the mandatory and optional limits for medical care, income replacement, death, funeral expenses and loss of income from disability.

What are standard accident benefits in Ontario?

There are several standard options for accident coverage which include:

CoverageBenefits
Income replacementIf you are unable to work, you may qualify for benefits of 70% of your gross income, capped at $400 per week. You have the option to increase of up to $1,000 per week.
Non-earnerIf you are unable to provide care to a dependent, you could receive compensation that would allow you to hire someone to help you care for them. This applies to specific injuries. You can add optional endorsements to include all injuries.
Caregiver benefitsIf you don’t qualify for income replacement, are a student, and cannot go back to the lifestyle you had before your accident, you may qualify to receive $185 per week.

Medical, Rehabilitation and Attendant Care Benefits

Some private health or government insurance plans cover medical or rehabilitation care, but this will help with those issues if you are not covered.

Mandatory coverage includes up to $65,000 for non-catastrophic injuries or up to $1 million for catastrophic injuries. You can increase the amount for non-catastrophic injuries to $130,000 and catastrophic injuries to $2 million.

CoverageBenefits
Medical and rehabilitation benefitsThis covers the cost of health care and rehabilitation, which includes physiotherapy, prescriptions, chiropractic, counseling, and other services not covered by OHIP or through your group plan (if applicable). Medical care and costs that qualify are listed in the statutory accident benefits schedule.
Attendant care benefitsIf you are unable to continue as a primary caregiver, you will be provided with assistance at your home or healthcare facility to help you recover from a serious injury. This helps single-parent families, families with one stay at home parent, and households with other dependents. It includes up to $250 per week and an additional $50 per week for each subsequent dependent living in the house
Death and funeral benefitsIf you die as a result of an auto accident, the insurance company will pay $25,000 to your spouse; $10,000 to each of your dependents; a maximum of $6,000 for funeral expenses; $10,000 to former spouses if the person had financial obligations to them. You have the option to increase limits up to $50,000 for your spouse, $20,000 to dependents, and $8,000 for funeral expenses.

Other related expenses

CoverageBenefits
Lost educational expensesCompensation for lost tuition, books and other education related expenses up to $15,000.
Expenses of visitorsReasonable expenses incurred by family and friends to visit you during recovery and treatments. Your spouse, children, grandchildren, parents, grandparents, siblings, certain other dependents, and guardians qualify.
Housekeeping and home maintenanceReceive up to $100 per week for reasonable expenses to help with housekeeping and maintaining your home while you recover.
Damage to clothing, glasses and other belongingsReceive compensation for damaged clothing, glasses and other personal medical devices damaged during the accident.
Cost of examinationsCompensation for the cost of examinations related to treatments as part of your recovery.

How to apply and settle your accident benefit claims

There are different ways and procedures the injured party must utilize to apply for and/or settle accident benefit claims:

Who can apply for accident benefits

Anyone who is a driver, passenger, pedestrian or bicyclist and is injured due to an automobile accident can apply for statutory accident benefits.

Who pays for accident benefits

When someone is injured in a motor vehicle accident, the priority of payment for health care services is:

  1. Ministry programs:
  • OHIP services
  • professional services arranged or provided through CCACs (community care access centres) such as nursing, physiotherapy, occupational therapy, speech language pathology, social work and nutritional services (subject to eligibility and maximum amounts payable);
  1. Private supplementary health and disability insurer and private employer plans;
  2. Auto insurance companies (statutory accident benefits available through injured person’s own automobile insurance policy);
  3. Money awarded in a lawsuit;
  4. Provincial government plans are the last payer for:
  • Non-professional services arranged or provided through CCACs such as personal support and homemaking services, attendant care services;
  • All services and benefits such as vocational rehabilitation and welfare payments, administered by the Ministry of Community and Social Services

 

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What are accident benefits for a passenger and pedestrian?

There are cases where you can sue an at-fault driver in addition to compensation you get from your insurance. Fault is determined by the Fault Determination Rules established under the Ontario Insurance Act.

What you can sue for?

If the driver was at fault, and you suffered a permanent serious impairment, you may be able to sue for pain and suffering, loss of enjoyment of life, and future health care costs. You might also be able to sue for any economic losses or out of pocket expenses that have not been reimbursed by your insurer. It’s difficult to determine economic losses so talk to your lawyer.

Accident benefits for passenger

As a passenger of an accident where the driver is at fault you have the right to sue the driver for compensation, losses or injury.

However, it’s really the driver’s insurance company that is being sued for a car accident in Ontario. Therefore, the insurance company is responsible for defending against the claim and for ultimately paying whatever compensation is determined through mediation or litigation.

That’s why if you are injured in a car accident where a relative was driving the car, you still might want to consider suing to gain compensation. It is their insurance company that will be on the hook for damages and not the driver themselves.

Accident benefits for pedestrian

If you were seriously hurt by a driver, you can make a claim under your automobile insurance policy or under the policy of the driver involved in the accident. If a driver was negligent in causing your accident, you can also sue the driver and his/her insurer for damages.

Types of forms that are required for accident benefit car insurance

To apply for SABS benefits the injured person must complete and submit the following forms:

OCF-1: The Application for Accident Benefits

This form is completed by the injured person or their representative.

OCF-2: Employer’s Confirmation

This form is completed by any employer that employed the injured person in the 52-week period before the accident. If the injured person is self-employed, they complete their own form.

OCF-3: Disability Certificate

This form is completed by a health practitioner (chiropractor, dentist, nurse practitioner, occupational therapist, optometrist, physician, physiotherapist, psychologist, or speech-language pathologist).

When to settle claims

It’s difficult to pinpoint exactly how or when to settle an accidently benefit claim. Each case may be different with nuanced SABS and legal tort claims. Evaluating this impact will depend on which version of the Insurance Act’s Statutory Accident Benefits Schedule (SABS) applies to your accident benefits (AB) claim.

Sometimes a quick settlement offer can be unfair but is not necessarily so in every case. Still, it is important to contact a lawyer to understand the fair value of your claim before you agree to a settlement.

If you sustained catastrophic injuries, you could settle your claim once you acquire your long-term care cost report and the accounting/auctorial report. In many cases, it’s prudent to wait until you get a prognosis to negotiate a claim settlement. But it’s always wise to talk your lawyer about your specific case.

The agency who oversees and regulates disputes

Frequently asked questions about statutory accident benefit

What if the pedestrian got hit by an uninsured drivers and the pedestrian has no insurance?

If you are a pedestrian or a cyclist and/or do not own or have access insurance, you can seek up to $200,000 in damages through the Motor Vehicle Accident Claims Fund (MVACF). The fund is also available to accident victims of uninsured drivers. The MVACF is considered the payor of last resort in cases where no accident benefit auto insurance exists to address a claim. It is only available to those living in Ontario for accidents that occur in the province. 
 

Who are entitled to accident benefit?

Accident benefits apply if you are injured as a driver, passenger, pedestrian or bicyclist due to a car accident. Coverage applies regardless of fault.

Is accident benefit coverage mandatory across Canada?

Yes. Accident benefit coverage is mandatory throughout Canada with one exception – Newfoundland.

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