Articles Posted in Accident Benefits

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On July 1st, 2026, the Ontario Government allowed all car insurers to change what benefits were benefits came standard under an ordinary car insurance policy. These changes did not benefit your average consumer. These changes benefited car insurers because they could ask for the same amount of money in premiums, yet be on the hook to pay out far less in benefits under that same policy.

Here are some of the benefits which used to exist under a standard car insurance policy before July 1st 2026, but were eliminated thereafter:

$185/week Non Earner Benefit x 104 weeks = $19,240 eliminated under standard policy

$400/week Income Replacement Benefit x 104 weeks = $41,600 eliminated under standard police

$3,000/month x 24 months = $72,000 eliminated under standard policy

Cost of Funeral = $6,000 Max Benefit eliminated under standard policy

Death Coverage for Surviving Spouse = $25,000 eliminated under standard policy

Death Coverage for Dependant Children = $10,000 per child eliminated under standard policy

These are some serious savings for Ontario Car Insurance Companies! These benefits were standard under a run of the mill car insurance policy. These benefits were available to people who didn’t have their own car insurance, but who were involved in car accidents themselves. Think of people like:

  • Pedestrians who were hit by a car through no fault of their own
  • Seat Belted Passengers who were involved in a car accident through no fault of their own
  • Cyclists who were hit by a car through no fault of their own

Before July 1st, 2026, all of the benefits detailed above were available to these people, whether or not they had car insurance, or not, under a standard auto policy.

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One of my jobs as a personal injury lawyer is to explain to our clients how the law works, and how the law applies to their case.

Most people have ideas about how the law should work. But, those ideas aren’t based on law, fact, or anything else. Rather their ideas about how the law works are based on feelings, or something they’ve heard in passing from a friend, colleague, or family member (usually not a lawyer).  People want to believe what they want to believe. They have preconceived notions about how car accident law, and Ontario’s laws surrounding compensation should work. This is based on what they perceive to be “fair” and how they perceive the system to operate without having done any research at all.

The biggest misconception about car accident law in Ontario is that it’s fair.

The cold, hard, truth is that the laws surrounding car accident law, and the way which Courts compensate accident victims in Ontario is NOT FAIR AT ALL.

I’ve never heard anyone say that laws were meant to be fair, in particular, man made laws.

In fact the laws were drafted in such a way as to minimize the exposure of car insurers as much as possible so that they can maximize their profits. In turn, those savings which the insurers presumably were making on lower exposure were supposed to be passed along to the consumer in the form of lower auto insurance premiums. This pipedream never happened. What we see instead is that everyday Ontario drivers are paying more in car insurance premiums; and getting less in terms of coverage and benefits. This is shrinkflation, only it’s harder to see and to understand because insurance is not a physical product that we can taste, see or touch. Nor is it a product which we purchase everyday at a store, or online. Insurance is a product which people use everyday in the background, but hope to never have to call upon in the event of an unfortunate accident. It’s for those reasons that people remain unfamiliar with how it works. I tell people all the time that buying insurance, and making a claim isn’t like buying a pair of shoes or a litre of milk at a store. It’s much more complicated than that.

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When is a car accident, a car accident?

This seems like a silly question, which shouldn’t matter in the grand scheme of things.

Why is it so important if it’s a car accident, or not?

There is potentially $1,000,000+ at stake if it’s deemed to be a car accident, or not. And here’s why.

In Ontario, we have a complex system of no fault accident benefits, which are only available if the accident is deemed a car accident (or an accident arising from the use or operation of a motor vehicle).

If it’s not deemed a car accident, then the injured accident victim will NOT have access to accident benefits. This means that they will not be eligible for an income replacement benefit ($400/week), attendant care benefit ($3,000/month),  or paid rehab benefits through a car insurer. Accident benefits provide interim support to injured accident victims. If the injuries ar very serious, they might be deemed catastrophic, which will allow the injured accident victim to access over $1,000,000 in accident benefits.

So, this seemingly mundane question of whether or not this was a car accident or not is a potential “million dollar question“. As such, you can see why lawyers put so much effort into answering these questions. There’s a lot at stake for the Applicant (injured accident victim), and the Respondent (the insurer).

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Last week a person called and told me about their car accident. It was pretty serious accident which took place at high speeds. The photos of the damage to the vehicles were frightening. Air bags deployed, cracked windshields, crushed bumpers, crumpled hoods and side panels. You couldn’t recognize the makes or models of the vehicles involved in the crash. It was like a scene out of a demolition derby, only it wasn’t an organized event for sporting entertainment. . It was real life. Everyone involved in the crash were luck to be alive.

The people involved in the car accident were rushed by ambulance to hospital. The x-rays and other digital imaging didn’t show any objective injuries. So, the doctors discharged the accident victims telling them to take some Tylenol or Advil, go see their family doctor, and to look in to getting physiotherapy. This might seem strange for some people who aren’t familiar with how car accident cases work, or with how Ontario hospitals work. But as a personal injury lawyer, I see this discharge routine all too frequently. If there isn’t anything broken, or which shows up on any scan or test, people are discharged from hospital fairly quickly in order to make room for the next patient to arrive. The responsibility is then on the client to see his/her family doctor, and arrange for physiotherapy.

But how do you go about arranging for physiotherapy, and who will pay for it?

These are great questions! It sounds easy enough to get physiotherapy, but it isn’t as easy as you would think.

The easiest way to get treatment after a car accident is to find a clinic near your home. Going to a clinic that’s hard to get to isn’t convenient for regular attendance at physiotherapy which is generally what’s required to see results. Once you’ve found a clinic nearby, the easiest way of getting treatment is paying for it out of pocket right there on site.

But that’s not fair considering that you weren’t at fault for the car accident; and considering that you have car insurance which is supposed to pay for this sort of treatment. Paying out of pocket also isn’t always an option due to financial constraints and because paying for regular treatment over the course of time gets very expensive.

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Car insurance cases are a lot about paperwork.

Completing the right paperwork. Completing that paperwork the right way, by the right professionals, and completing the paperwork on time. If you’ve done those things, then you are well on your way. While there are no guarantees at success, getting the paperwork done correctly will ensure that your claim doesn’t fail before it even gets started.

Once of the small changes we’ve seen over the past 2 years are the changes to the OCF-1 Application for Accident Benefits.

The OCF-1 Application for Accident Benefits is the FIRST and MOST IMPORTANT form which you can file with your car insurer after a car accident.

If you file this form properly and on time, your accident benefit claim will be live and open. Subsequent forms and documents can be filed afterwards. The OCF-1 Application for Accident Benefits is the form that gets the ball rolling. If you don’t fill out the OCF-1 Application for Accident Benefits, you won’t be able to have an accident benefit case; and it will also have an impact on your tort claim for pain and suffering against the at fault driver. Not to mention that you won’t have any access to medical/rehabilitation benefits to get you better; or access to any attendant care benefits (up to $3,000/month), income replacement benefits (up to $400/week or more if you purchased optional benefits) or non-earner benefits ($185/week).

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Cases can be similar. But not the same. No two cases are alike.

The same can be said for Judges. They can be similar, but they aren’t the same. No two Judges are alike; nor do they see things alike.

But, what the public and what personal injury lawyers look for is consistency in judicial decisions. When there are legal principals which address the same point; the same law ought to be applied; and should result in a predictable outcome once the law is applied to the case at hand.

We are going to share with you two cases, which dealt with the exact same thing. Yet, the outcomes were completely different! This doesn’t happen often, but it can happen.

Both cases involve car accident cases dealing with minors (people under the age of 18). When there is a Plaintiff, or a claimant under the age of 18; personal injury lawyers and insurance companies seek for Judges to approve of the settlement. There are many policy reasons for this. It’s a good public policy to protect the interests and the rights of minors. We want to make sure that the settlement is equitable and just. We want to make sure that the minor’s funds aren’t misappropriated. We don’t want the minors coming back to the Courts once they’ve hit the age of majority and suggest that the settlement was improvident; or something which they should never have agreed to in the first place. These policy reasons are important both for Plaintiffs and Defendants alike.

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Part of the secret to defending a personal injury case, isn’t in the defence of the case on its merits itself. Rather, it’s all about trying to find alternative sources of income or benefits which the Plaintiff is entitled to so that that money offsets any potential award. This way, if even if an at fault Defendant or large insurer looses the case; their damages exposure is limited by the amount of collateral benefits which a Plaintiff has received; or which a Plaintiff is entitled to.

The term collateral benefits is often misunderstood by Plaintiffs, or disability claimants. But, it’s a very important term for any Plaintiff in a personal injury case to understand.

Think of collateral benefits as an amount of money (or benefit) which a Plaintiff is entitled to. The Plaintiff may be receiving that money; or they may not. The money might not be coming in because the Plaintiff has not applied, or thought of applying for that benefit. We see this frequently. There is no playbook for getting injured. Nor is there a playbook for what benefits to apply for after a serious accident, injury or disability claim. Many Plaintiffs don’t know that they might be entitled to benefits; or they don’t know how or when to apply for said benefits. Unfortunately neither the law nor insurers care about that. If you are entitled or eligible for said benefit, you should apply even if you didn’t know the benefit existed. The law will treat the Plaintiff as if they knew about said benefit, and as if they were eligible to receive said benefit; even if they didn’t receive it. The set off will be applied irrespective of whether or not the application for the benefit was made or not.

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In school, you’re not taught what to do after a serious car accident. There is no course or classroom lesson. This is something which people will learn from friends, family members, lawyers, reading, or through life experience.

While car accidents happen everyday,  the same people aren’t involved in car accidents everyday. They are the exception, and not the norm for individuals. But, the opposite is true for insurance companies. They handle hundreds of calls a day, and thousands of cases each year across the country. Handling car insurance cases is part of their business model. They are familiar with the ins, and outs, and what has to get done in order to process a claim and see it through.

Our personal injury lawyers have seen that people want advice in their time of need right after a car accident. They don’t know where to turn, what to do, or who to trust. Innocent accident victims are shaken up, and in a vulnerable state. They want to trust their insurance company to given them advice, and to point them in the right direction. But, the insurer has their best interests in mind, and not yours. They will try to set up the claim in such a way as to best limit their exposure in an effort to maximize their profits. So, injured accident victims need to beware, and take everything which the insurance company says with a grain of salt (or a large mound of it). The relationship between injured accident victim and insurance adjuster can get off on the right foot, but can quickly sour thereafter. A few denials here and there. An assessment with an “independent” specialist to justify a denied treatment plan. Things can get messy really quickly. Here are some quick tips on things to avoid with your insurance company following a serious car accident:

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There are so many tall tales in personal injury law. Things which you hear from your friends, family, therapists, neighbours, acquaintances, or random people in your community are so far off from the reality of what actually happens behind the scenes, and the work involved in a personal injury case.

The only people who really know what happens, and how things happened are the lawyers themselves.

There are a lot of reasons for this.

For starters, personal injury cases deal with new litigants, who are unfamiliar with personal injury cases, or how the law works. This is completely normal as for the majority of clients, it’s their first time hiring a personal injury lawyer, or a lawyer all together. When you are new to litigation, it’s hard to understand how things get done. It’s perfectly ok to be a first time litigant. In fact, if you’re a multiple time litigant for a personal injury case, it will give your lawyer cause for concern. You must be terribly unlucky, finding yourself repeatedly in the wrong place, at the wrong time. You will also likely have an extensive pre-accident history which will invariably come up in your personal injury case.

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Most people aren’t familiar with how car insurance disputes work until they have to go through the process.

Most would think that if there’s a dispute for benefits, they can sue the insurer which is denying those benefits and then a Judge can decide. That seems simple and straight forward. Unfortunately, simple and straight forward is not the way which car accident cases work in Ontario.

Long ago, accident victims had the right to sue the insurance company which was denying their accident benefits following a car accident. That case could be heard by a Judge, in regular Court. The court date however would only trigger if the parties had attempted and failed a mediation at the Financial Services Commission of Ontario (FSCO). That way, the parties gave it an honest try to see if they could resolve their dispute at mediation, without the need for litigation in Court. This made a lot of sense, and was easy for unsophisticated and inexperienced litigants to understand.

But the rights of accident victims to sue over denied accident benefits following a car accident were stripped from everyone in Ontario. Yes: imagine that. In a democracy, the government took away your right to sue, and access to the Courts.

Instead, innocent accident victims were required to have their disputes heard at the License Appeals Tribunal (LAT). The LAT is not a Court. It’s a tribunal. There are no Judges at the LAT. Instead, there are adjudicators who work there, who may, or may not, have any experience hearing or ruling on car accident cases. The barrier to entry to become an adjudicator at the LAT is much lower than the barrier to entry to become a Judge of the Ontario Superior Court of Justice.

Since the LAT became the ruling body over accident benefit disputes, it’s been an unfriendly place to accident victims (likely by design), and surrounded with controversy. It’s a really strange place.

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