When you have been injured in a vehicle accident, you should seek medical care. Depending on the severity of your injuries, you may also have to undergo therapy. You can experience emotional and physical pain, and this can drain your finances. This can affect your life and the lives of your family.
Knowing who will shoulder the medical bills after an accident can take away the worry about where you will get the money for your treatments.
This article discusses who is responsible for paying medical expenses for a car accident in Ontario.
No-Fault Insurance System In Ontario
Ontario operates under the no-fault insurance system. Under this system, insurance companies are mandated to make payments for medical costs in motor vehicle accidents, regardless of who was responsible for the accident.
Therefore, Ontario residents involved in car, bicycle, motorcycle, and truck accidents are entitled to receive accident benefits from their own insurer. Amongst other things, these benefits cover some but not necessarily all of the treatment/medical costs you may incur following an accident. They do not cover property damage to your vehicle and that is reimbursed through another section of your policy.
For medical expenses not covered by your own insurer (or another private plan you may have), you can pursue the at-fault party and their insurance company. This will almost always involve commencing a lawsuit against the at fault party in which these claims are advanced. For this reason, you should consult an experienced car accident lawyer right after your accident.
Having the no-fault insurance system in Ontario does not guarantee that all your medical bills will be paid.
A skilled car accident lawyer can help you get the accident benefits to which you are entitled.
When you hire a car accident lawyer, they will help ensure that the insurance company will not misclassify your injuries, resulting in significantly reduced coverage. Your personal injury lawyer can assist in convincing your own insurer to properly classify your accident injuries and can help you pursue the at-fault party for additional compensation.
“I have worked with insurance companies, and I know how they deal with claims. I am skilled at negotiating with insurers, and I can help you recover the insurance benefits to which you are entitled.”
Derek Wilson
Car Accident Lawyer
In Ontario, your insurer can provide accident benefits to pay for your medical treatment, but there are limits to the coverage.
Payment Options You Can Use
- Ontario Health Insurance Plan
- No-fault Auto Insurance
- Deferred Payment
Ontario Health Insurance Plan (OHIP)
In Ontario, this also covers your hospitalization.No-Fault Auto Insurance
Ontario no-fault insurance covers certain medical and rehabilitation benefits.
Deferred Payment
Sometimes your car accident lawyer can help you work with your treatment providers after an accident claim is made against the at-fault party and will await payment for their services until you receive your settlement.
Benefits To Which You May Be Entitled To Following A Car Accident
Pain And Suffering (Non-Pecuniary General Damages)
If you sustain permanent and serious injuries (physical or psychological), you can sue the other driver for the pain and suffering that you feel. The judge will decide whether your injuries are permanent and serious based on medical evidence. If you meet this threshold and are awarded compensation for pain and suffering, in most cases, a deductible amount applies. At the time of writing this, it is almost $40,000. Moreover, the deductible is indexed to inflation and increases every year. So if your pain and suffering was assessed at $70,000, after you subtract the deductible, you would be left with approximately $30,000.
Loss Of Income And Earning Ability
- Loss of Income Benefits
- Non-earner Benefits
Loss Of Income Benefits
You may claim compensation for present and future loss of income and earning ability. These benefits do not require your injuries to be serious or permanent. You do need to prove however that your accident injuries prevented you from working or taking a job, etc. You can claim up to 70% of the gross income you lost from the at-fault driver, starting at seven days after the accident up until the time of Trial and then 100% of the gross income lost thereafter.
You may also be entitled to Income Replacement Benefits from your own insurer. Again these commence after seven days following the accident and are also limited to 70 percent of your weekly gross income up to a maximum of $400 per week in most cases. If you are entitled to receive Income Replacement Benefits, the insurer for the at-fault party gets to deduct the full amount of these from an income award they may be required to make.
Non-Earner Benefits
This is applicable if you were unemployed at the time of the accident. The “non-earner” benefit is $185 per week for a maximum of two years, after a waiting period of four weeks. This benefit only applies to the claimant who suffers a complete inability to perform normal day-to-day activities due to the accident and within 104 weeks of the incident. This also applies if you are not qualified for Income Replacement Benefits, are no longer qualified for Caregiver Benefits, was a full-time student, or have completed your education but have not been employed yet.
Types Of Non-earner Benefits
- Medical, Rehabilitation, and Attendant Care Benefits
- Minor Injury
- Non-catastrophic Injuries
- Catastrophic Injuries
- Claims of Family Members
- Housekeeping and Home Maintenance As Against Your Own Insurer
- Caregiver Benefits As Against Your Own Insurer
- Death Benefits and Funeral Costs
Medical, Rehabilitation, And Attendant Care Benefits
Minor Injury Guidelines
If your injuries are deemed minor by the applicable legislation, you only have $3500 available for medical and rehabilitation benefits.
Non-Catastrophic Injuries
Examples of non-catastrophic injuries include serious muscle tears, broken bones and psychological injuries. In these cases, benefits are increased to a maximum limit of $65,000 in most cases.
Catastrophic Injuries
Examples of catastrophic injuries are a complete loss of vision, losing a limb, or paraplegia. These benefits have a maximum limit of $1,000,000 for medical benefits.
Claims Of Family Members
Under the Family Law Act of Ontario, the claimant’s family members may also sue for loss of guidance, care, and companionship if you have a permanent and serious injury resulting from the accident. This also applies if the injured person dies.
Family Law Act claims are subject to a $19,409 deductible except when the claim is more than $64,697 or where death occurred because of the accident. Again, this deductible arises every year.
Housekeeping And Home Maintenance As Against Your Own Insurer
Unless you have paid for the optional benefit, this benefit can only be claimed by people who suffer a catastrophic injury. If you cannot maintain your home as you did before the accident, you can claim for reimbursement of the expenses you incurred for housekeeping and home maintenance up to a maximum of $100 per week. If you are prohibited from claiming these expenses against your own insurer, you can advance a claim for housekeeping against the at-fault driver’s insurer.
Caregiver Benefits As Against Your Own Insurer
Unless you have paid for the optional benefit, this benefit can only be claimed by people who suffer a catastrophic injury. Suppose you were a caregiver when the accident happened, and you can no longer perform your caregiving duties. In that case, you may be entitled to receive reasonable costs of paying for professional care up to a maximum of $250 per week, plus $50 for each additional child.
Death Benefits And Funeral Costs
In case of death, the amount of $25,000 is payable to the deceased spouse, and an additional $10,000 is payable to each of the deceased’s dependents.
The maximum payment for funeral expenses is $6,000.
Testimonial
“I was in an MVA in 2017 and suffering from multiple injuries. I didn’t seek out legal advice for one year after the accident because I didn’t want to go through the long legal process. This was new to me. I received a referral to contact Derek because my conditions were not improving. The person who gave me the referral highly recommended Derek! After my initial meeting, I retained Derek. He was honest & straightforward, which I appreciated. I want to thank Derek, & his team for making the process simple! Derek settled my accident benefits & tort case in a timely manner during Covid 19 with fair results! Highly Recommend!”
L.F. – Ontario
FAQs
How will I know if I can claim accident benefits?
Any individual injured in a car accident is generally entitled to accident benefits. You can file a claim for accident benefits whether you were the driver, passenger or pedestrian hit by a motor vehicle.
What provinces are covered by the no-fault system in Canada?
Ontario, New Brunswick, Nova Scotia, Prince Edward Island (PEI), and Quebec are all covered by a no-fault system.
How long will it take to settle a case?
A case is generally settled within two to three years from the date of the accident. However, some cases do take longer. Accident Benefit cases cannot be settled before a year has passed from the accident’s date to the settlement date. The injured person’s recovery is the most crucial factor that will help determine when a case should be settled. Suppose it takes longer to understand the full impact of an individual’s injuries on their life and future. In that case, the case may take longer to finish so that all the injured party’s needs are identified and reported, and appropriate compensation for all losses is pursued.
Contact Derek Wilson Personal Injury Law at 905-769-0418 to schedule a free no-obligation consultation.
