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Insurance

Know Your Rights And Benefits

DID YOU KNOW THAT?

As of November 1996, you have the right to claim the following benefits even though you are at fault for the accident.

- Up to $100,000 for medical and rehabilitation benefits for 10 years from date of the accident;

- Up to $72,000 for attendant care benefits for 2 years from the date of the accident;

- Income Replacement Benefits if you are unable to return to work as a result of the injuries sustained in the accident;

- Non-earner benefits of $185 per week;

- Caregiver benefits in the amount of $250 per week for the first person in need of care and a further $50 per week for each additional person in need of care;

- Lost education expenses of up to $15,000 for expenses incurred prior to the accident for tuition books, equipment, and room and board.

- All reasonable and necessary expenses of visitors;

- All reasonable and necessary expenses incurred for housekeeping and home maintenance services up to $100 per week.

Additionally, if the accident was not your fault you may be able to claim money from the at fault drivers’ Insurance Company for:

- Pain, suffering and lost enjoyment of life due to permanent serious impairment or disfigurement (i.e. scarring)

- Lost income, both past and future;

- Income losses if you are self-employed


Ontario Auto Insurance Laws

You are injured in a car accident and you require treatment for your injuries. There is information you should know about Medical and Rehabilitation Care Benefits. This document will assist in explaining the coverage for which you may be eligible.

If after reading this you still have questions, please contact your automobile insurance representative. For additional information, you may call the Insurance Bureau of Canada Consumer Information Centre. The telephone numbers are listed below. If there is a disagreement about payments and it cannot be resolved, the Ontario Insurance Commission can be called in to help find a solution. To find out more about OIC dispute resolution services call 1-800-517-2332 or in the Toronto dialing area (416) 250-6714.

There is not enough space here to deal with every detail of the laws covering Statutory Accident Benefits. You should not rely on this document as legal advice. It does not contain all aspects of the auto insurance legislation. For the precise wording of the law you should consult the Ontario Insurance Act and the Statutory Accident Benefits Schedule made under that Act.


What are Medical Benefits?

Medical Benefits include payment for all reasonable and necessary expenses incurred as a result of an automobile accident in which you were injured.

The coverage includes reasonable and necessary expenses for:

- medical, surgical, dental, optometry, hospital, nursing, ambulance, hearing testing and speech therapy services;

- chiropractic, psychological occupational therapy, physiotherapy, services;

- medication;

- prescription eyewear;

- dentures and other dental devices;

- hearing aids, wheelchairs or other mobility devices, prostheses, orthotics and other medical devices;

- transportation to and from treatment including transportation for an attendant;

- other required goods and services of a medical nature

NOTE: Your insurance company is not obliged to pay for any goods or services that are considered experimental.


What are Rehabilitation Benefits?

The Rehabilitation Benefits are for the payment of expenses incurred by you or on your behalf, provided you have been injured in a motor vehicle accident.

The coverage is for costs incurred for reasonable and necessary measures to:

1. reduce and eliminate the effects of the disability resulting from the injury or;

2. assist you in reintegrating into a family role, or labor market (if you had a labor force attachment) and also see your community.

The coverage includes reasonable and necessary expenses for:

- life skills training;
- family counseling;
- social rehabilitation counseling;
- financial counseling;
- employment counseling;
- vocational assessments;
- workplace, home and vehicle modifications;
- transportation for the insured person and an attendant and from various treatment sessions, training sessions, assessments and counseling sessions;
- other goods and services required that are rehabilitative in nature.


Do I Qualify for Medical and Rehabilitation Benefits?

It is important to understand that the expense incurred must be as a result of the injury you sustained in the motor vehicle accident, as well as being reasonable and necessary. Your insurance company may require that the application include a treatment plan prepared by a health professional. The plan would include a description of the impairment and resulting disability and of the goods and services to be used in the treatment. Your insurer will respond to the treatment plan within 14 days of receiving it. If the plan is acceptable the insurer will pay for expenses within 30 days of receiving invoices. If any part of the plan is not accepted the insurer will treat this as a dispute and send you to a Designated Assessment Centre.

Any medical and rehabilitation coverage available to you through other sources must be accessed first.


How Much is Payable in Medical and Rehabilitation Benefits?

If your injury does not result in a catastrophic impairment, benefit payments will be up to a maximum of $100,000. If your injury does result in a catastrophic impairment, benefit payments will be up to a maximum of $1,000,000. You may have purchased higher benefits. See your insurance broker or agent.


Ontario Laws Affecting Payment of Accident Benefits

On November 1, 1996, the Ontario government put into effect a new law which will affect the way you make a claim with your insurance company if you are in n automobile accident. These changes will also affect the way the claim is handled and the amount you will receive. This document will help explain the laws concerning the payment of benefits to people who suffer a disabling injury as a direct result of an automobile accident.

If, after reading this, you have questions, please contact your automobile insurance broker or agent, or you may call the Insurance Bureau of Canada Consumer Information Centre.

There is not enough space in this document to deal with every detail of the laws covering statutory accident benefits. It does not contain all aspects of the auto insurance legislation. For the precise wording of the law, you should consult the Ontario Insurance Act and the Statutory Accident Benefits Schedule made under that Act.

If you have a dispute with your insurer about your accident benefits claim, you have the right to apply to the Ontario Insurance Commissions for dispute resolution services. To find out more about the OIC dispute resolution services call 1-800-517-2332 or in the Toronto dialing area (416) 250-6714.

If you suffer a disabling injury in a car accident, you must tell your insurer within 30 days of the accident, or as soon after that as possible, that you wish to apply for benefit payments. You must send your application for benefits within 30 days of receiving the application forms. The forms will be supplied by your insurer.


Who is eligible for benefits?

Any person who is injured in an accident or who suffers psychological or mental injuries because of an accident that injures certain relatives or dependents.

If you are insured under more than one policy, there are special rules that determine from which policy you are eligible to receive benefits.

You are not eligible to receive income replacement benefits, non-earner benefits, lost education expenses, expenses of visitors and housekeeping and home maintenance benefits if you were:

- driving without a valid license;

- driving a vehicle where you knew or should have known you were driving without the owner’s consent;

- a passenger who knew or should have known the driver did not have the owner’s consent to drive the vehicle;

- driving when you knew or should have known you were driving without valid insurance;

- convicted of impaired driving or refusing to provide a breath sample;

- convicted of a criminal offense arising out of the use of an automobile in connection with criminal activity;

- knowingly misrepresenting any important information when applying for auto insurance;


What are the benefits?

The following are brief descriptions of the types of benefits for which you may be eligible. For more complete descriptions and to determine if you are in fact eligible for any of the following benefits you should contact your broker or agent who will have more detailed information sheets explaining the various benefits.

- Income Replacement Benefit
If you are eligible, this weekly benefit will partially compensate you for the loss of your income if you cannot work because of your injuries.

- Non-earner Benefit
If you are eligible, this benefit would compensate you 26 weeks after the onset of your complete inability to carry on your normal activities.

- Caregiver Benefit
If you are eligible, this weekly benefit will reimburse you for expenses having incurred if you cannot continue as the main caregiver for a member of your household who is under 16, or who is over 16 and suffers from a disability.

- Medical and Rehabilitation Benefit
This benefit will pay for reasonable and necessary medical and rehabilitation expenses not covered by a government health plan or supplementary health plan you may have.

- Attendant Care Benefit
This benefit will pay reasonable and necessary expenses for a caregiver or attendant that you require as a result of the accident.

- Other Expenses Benefit
This benefit will pay for other expenses such as lost educational expenses, expenses of visitors, the reasonable cost of housekeeping and home maintenance and repairing or replacing certain items lost or damaged in the accident.

- Death and Funeral Payments Benefit
There are lump sum payments available for survivors of a person killed in an accident and to help pay for the expense of a funeral.


Additional Information and Help

If you have any questions about the legislation or how to make a claim, contact the following:

Your own agent or broker

Insurance Bureau of Canada 1-800-387-2880
Or (416) 362-9528

 

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