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Benefits in a Slip and Fall Case and How to Claim them

Slip and fall accidents resulting in serious injuries can be very difficult on the innocent accident victim; particularly when it comes to making ends meet.

How and when will lost wages be paid?

How and when will treatment costs not covered by OHIP be paid (physio, massage, chiro etc.)?

Will attendant care services be available and if so; who will pay for those services?

How do my out of pocket expenses get paid?

What about my damaged glasses or clothing? Will I be compensated for that; and if so; when?

These are all valid questions and concerns which a number of our slip and fall or trip and fall clients have expressed to our personal injury lawyers.

In a car accident case, all of these items are covered through Ontario’s no fault accident benefit coverage. That’s means that so long as you meet the disability test(s) for these benefits; and they are deemed to be reasonable and necessary, these benefits will be paid out to the accident victim.

In a trip and fall case, or slip and fall case, accident benefits are NOT available to the innocent accident victim. There is no interim insurance (unless privately purchased) which will cover these heads of damages. The Plaintiff will have to wait until the end of the case in order to get compensated for these damages.

This is why slip and fall, or trip and fall cases resulting in serious injury can be so difficult for accident victims because more often than not, there’s no interim money coming in until the case settles or there is a favourable judgment at trial. It can take a number of years for a case to progress through the Court system, or to get settled outside of Court for that matter.

So what’s a Plaintiff to do when they are waiting to get compensated for their injuries?

For starters, it’s important to check with your personal injury lawyer to see if accident benefits, or any other form of collateral benefits are available to you.

It’s amazing how many people don’t lawyer up; or consult a personal injury lawyer too late in the process; only to find out that they’ve left thousands of dollars on the table by not making a timely claim.linkedin-2-300x300

Some slip and fall or trip and fall cases are eligible for accident benefits. The slip and fall or trip and fall needed to be deemed as an accident arising out of the “use or operation of a motor vehicle“. This definition has been treated rather broadly by the Courts and Tribunals which hear car accident cases (formerly FSCO, and now the LAT).

Slip and fall on ice getting out of your car? That will qualify as “use or operation of a motor vehicle“.

Slip and fall on a pot hole trying to get in your car? That will qualify as “use or operation of a motor vehicle“.

Take two steps exiting your car after shutting the door with keys still in hand and fall down? That will qualify as “use or operation of a motor vehicle”.

Changing your tire at the side of the road and fall down? That will qualify as “use or operation of a motor vehicle“.

Hitching a tow line to a trailer and slip and fall? That too will qualify as “use or operation of a motor vehicle“.

Packing groceries in your trunk, then walking to the driver side door when you slip and fall? Check.

Car wash when you fall down? Check.

Dumping trash in to a dumpster from your car and then slip and fall feet from the car on the way back to the vehicle? Check.

I think you get the point. The definition is a fairly broad one and will qualify a Plaintiff to some very helpful benefits which they otherwise would not have. Personal injury lawyers know about this sort of thing. The general public doesn’t. While we cannot speak for the insurance industry, your premiums likely won’t go up should you make an accident benefit claim given that you were a pedestrian at the time of the slip and fall accident. It’s considered a not a fault accident and a non moving accident without violation. We’ve never seen a person charged by the police in relation to a slip and fall accident. The fact that an insurer would consider increasing your premiums for a non moving pedestrian related accident is far fetched. If your insurer does that to you, imagine what they would do to you if were actually driving! Perhaps it may be a good idea to find a different car insurer.

But what happens if there was no motor vehicle in the picture? Where can an accident victim turn to next?

Certainly his/her own private insurance (if any) must be examined. Some people have access to short term disability, long term disability, extended health benefits, mortgage insurance, or even benefits which will pay for the services of a PSW or caregiver. All of these benefits need to be examined by the claimant as they will be very helpful if they are available.

If these private benefits are not available, then a Plaintiff should check what government benefits are available. EI Disability Benefits are available if you are not medically able to work on account of injury. These benefits will pay up to 15 weeks of benefits at a rate of 55% of your earnings; up to $595/week. Note that this $595/week is MORE than the standard income replacement benefit via accident benefits which pays only $400/week!

Once these benefits expire, you may want to consult with your family doctor about apply to CPP Disability Benefits. These benefits are available in the event that your injuries are both serious and prolonged and will help the accident victim make ends meet while they cannot work. Your family doctor or nurse practitioner needs to be on board with the application.

Other government benefits include Ontario Works or ODSP. In the case of ODSP benefits, if the recovery in the personal injury case exceeds $100,000; then the Plaintiff will need to repay ODSP part of their award depending on how much financial assistance they’ve received through the program. The first $100,000 is excluded.

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