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Accident Benefit Claims

Continuing with our COVID theme of straight facts and no filler or wonky political spin, for this week’s edition of the Toronto Injury Lawyer Blog, we will be focusing on Accident Benefit Claims in Ontario.

Why are we doing this?

Because we are finding so much misinformation going around right now during the Pandemic, we want to give people easy to understand legal information which won’t take forever to sort through. It also won’t require the reader to be a political analyst or medical expert to understand.

We want to make things easier for people when they need a quick resource for legal information following a serious car accident. Your time is valuable. This is our attempt to save you some time sifting through the internet for answers.

Accident Benefit Claims

Ontario has a no fault system of accident benefits.

That means that regardless of whose fault the car accident is; a driver, passenger, cyclist, pedestrian who was involved in a motor vehicle collision is entitle to claim accident benefits.

Accident Benefits are NOT damages for pain and suffering. Damages for pain and suffering are a completely different thing altogether. Don’t confuse the two. Damages for pain and suffering are referred to as “tort claims”.

Accident benefit claims are made to your own insurance company, regardless of fault.  That means that even if the other driver was drunk, speeding and ran a red light, the accident benefit claim is STILL MADE TO YOUR OWN INSURANCE COMPANY. Fault does NOT enter the equation when assessing accident benefit claims.

Fault later comes in to the equation for tort claims.linkedin-2-300x300

It may seem silly that your own insurance company has to pay out accident benefits even if the accident is not your fault. But that’s the way the law works. And because the law works this way, it can get very confusing for people to understand. It gets even more confusing when one person does not have proper car insurance, or there are coverage issues.

In those cases, insurance companies fight with one another over who will pay. Lawyers refer to these disputes as “coverage disputes”. Coverage disputes are most often fought between insurers, and the injured accident victim has little to no say in who pays. At the end of the day, does the injured Plaintiff really care whether or not accident benefits are paid by multi billion dollar Insurance Company “A” or multi billion dollar Insurance Company “B”. So long as benefits get paid, and those benefits are paid in a timely manner is all that matters.

What do Accident Benefits Cover?

Let’s be very clear. Accident Benefits do NOT cover damages for pain and suffering. They cover specific, predetermined things such as:

  • Income Replacement Benefits up to $400/week (or more if you purchased optional benefits)
  • Non Earner Benefits up to $185/week for a maximum of two years (if you are deemed non catastrophic)
  • Attendant Care Benefits up to $3,000/month to a max of $65,000
  • Medical and Rehab Benefits for such things as Physiotherapy, Chiropractor, Massage Therapy, Psychological Counselling and any other treatment deemed both “reasonable and necessary” which isn’t covered by OHIP. The limits for Med/Rehab Benefits vary at differing levels from $3,500, to $65,000 up to $2,000,000 for catastrophically injured accident victims
  • Case Management Services for catastrophically injured accident victims
  • Payment of prescription medication, visitation expenses, out of pocket expenses, and travel over 50km for appointments deemed to be “reasonable and necessary

Do Accident Benefits Get Paid Automatically?

No. In order to recover accident benefits, all of the accident benefit forms need to be completed on time, in the right way. In addition, the injured claimant needs to meet a variety of medical tests. In addition the insurer will want to be satisfied that they have sufficient medical evidence to justify the payment of benefits. They will want tax returns, hospital records, records from any doctors or specialists, your employment file, pay stubs, etc. It’s a lot of jumping through hoops for the injured accident victim which is not only very cumbersome and tiring, but also very frustrating.

How long do I have to make an Accident Benefit Claim?

You must submit your accident benefit claim within 30 days from the date of the subject motor vehicle accident. Failure to do so may negate your claim. Delays in submitting an accident benefit claim will no doubt slow down the flow of benefits to the injured accident victim. A delay may even trigger a higher level investigation by the insurance company to determine whether or not there is a reasonable explanation for the delay. These higher level investigations come in the form of statements and sworn examinations under oath which are tedious, time consuming, pressure filled and no fun. They say that justice delayed is justice denied. The same maxim can apply to accident benefit claims. Submitting an accident benefit claim late can result in benefits delayed or denied as well. Laziness, procrastination and a failure to take action will get you nowhere when dealing with an insurance company. Money in the form of benefits don’t fall down from the sky.

Do I need to hire a personal injury lawyer to file an accident benefit claim?

If you’ve been involved in a serious motor vehicle accident, it costs you nothing to contact the lawyers at Goldfinger Injury Lawyers. If we can help you with your case, we would be pleased to do so. Fighting an insurance company to get the benefits you need shouldn’t be done alone. The system is far too complex, rigid and there is too much at stake if you should lose.

Our personal injury lawyers see crucial mistakes which people make when they attempt to file accident benefit claims on their own. Moreover, the insurer knows when people are self represented and they take advantage of the situation in various ways. One of their most common tactics is insisting that the seek rehabilitation from one provider over another who will invariably frame the case in such a way so as to favour the insurance company and work against the injured accident victim.



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