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What’s Covered Under Accident Benefits in Ontario

Oct 23, 2020 | Accident Benefits Claims, Legal Articles

Moussa Sabzehghabaei

Personal Injury Lawyer

In this section, we will discuss Accident Benefits, which are available for persons who are involved in motor vehicle accidents. We will highlight the standard limits for all accident benefits according to Ontario’s Statutory Accident Benefits Schedule (SABS). Note that policyholders do have the option of purchasing optional benefits that can modify or increase their available coverage under the SABS.

What’s covered under accident benefits in Ontario?

It is mandatory for all standard Ontario auto insurance policies to provide for accident benefits coverage in accordance with the Statutory Accident Benefits Schedule. Accident benefits involve mandatory coverage that can be applied for immediately after someone is injured in an accident, and they can potentially apply to drivers, passengers, bystanders, and pedestrians – regardless of who is at fault. In view of the absence of a fault requirement, this system is sometimes referred to as the “no-fault accident benefits system”.

Accident benefits in Ontario cover:

  • Attendant care expenses: If a claimant is unable to perform daily activities such as bathing, toileting, dressing and feeding due to the injuries sustained in the accident, this personal benefit should cater for all expenses for an attendant or long-term care facility. The maximum standard coverage for attendant care benefits is $65,000.
  • Medical and rehabilitation costs: This section covers any expenses for medication and rehabilitation (i.e. treatment such as physiotherapy, massage, etc.) as a result of your injuries. The coverage is limited to $65,000 for non-catastrophic injuries and $1,000,000 for catastrophic injuries. You may choose to purchase optional coverage offered by your insurer in order to be covered for up to $2,000,000 in the event of qualifying under catastrophic impairment, and up to $1,000,000 for non-catastrophic injuries.
  • Caregiver expenses: If you were a primary caregiver in your family and the injuries sustained after the car accident have made it impossible for you to continue providing for your loved ones, this benefit will ensure that your household expenses are accounted for. There are limits to how much will be provided to cater for these costs. For instance, you only qualify for $250 per week for looking after the first dependent and an additional $50 per week for each subsequent dependant in your household.
  • Income replacement benefit: Those who are unable to work due to the injuries sustained after the accident can be compensated for the loss of income under this benefit. The benefit has a limit of a maximum of 70% of your gross weekly pre-accident income or $400 every week, whichever is less.
  • Death and funeral benefits: If the accident resulted in death, there is a lump sum pay-out given to your spouse and dependants. This amount should cover funeral expenses and there are some limits. For instance, a maximum of $25,000 will be paid to the person’s spouse, $10,000 to each dependant, and $10,000 to a former spouse who the insured person was supporting financially.
  • Non-earner benefits: If the insured doesn’t qualify for income replacement benefit but suffers a complete inability to lead a normal life, he/she may still qualify for the non-earner benefit. This benefit is also meant for students who are no longer able to carry on with their normal life because of the accident.

Accident Benefits may also provide coverage for other expenses such as lost educational expenses, transportation costs, housekeeping, and home maintenance expenses. Since the mandatory accident benefits coverage that is available under most standard auto policies is fairly limited, it is recommended that you consider speaking to your auto insurer about purchasing optional benefits that can increase your coverage and sufficiently protect you and your family from the significant medical and financial stress that a serious motor vehicle accident can cause.