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Fatality Claims in Ontario can be confusing

If you are reading this entry in the Toronto Injury Lawyer Blog, then likely a loved one, family member, dear friend or acquaintance has passed away as a result of the negligence of another party.

We are sorry for your loss.

Thoughts, prayers and well wishes from others are great, but sometimes they aren’t enough. You need action. And that’s where my law firm comes in.

Goldfinger Injury Lawyers has a proven track record of results in getting families the compensation they deserve following the untimely death of a family member as a result of the negligence of another party. Full disclaimer here: past results are not indicative of future awards. We have to include that disclaimer because we’re lawyers.

Many of the fatality claims that we see come as a result of a motor vehicle accident (car vs. car, car vs. truck, bike vs. car; pedestrian vs. car; motorcycle, etc.). Thousands of pounds of steel, metal, aluminium in the form of a motor vehicle travelling carelessly at high speeds will cause devastating and fatal injury.

Here is where things can get confusing for the general public.

When the fatality claim takes arises out of a motor vehicle accident caused by the negligence of another, the family will have 2 claims.

The first is the obvious claim for damages against the at fault party. The at fault party’s insurer will respond to this claim. In the event that the at fault party was driving without any car insurance, don’t worry! There are priority rules which set out how insurance coverage will work. In the event that the personal injury and insurance lawyers run down each insurance option and still can’t find insurance, then the claim will end up with the Ontario  Motor Vehicle Accident Claims Fund. The Fund is an administrative arm of the Ontario Government which deals with uninsured claims. The limit on Fund payouts sit at just $200,000 per accident. This is a low amount compared to a standard automobile policy in Ontario with limits of $1,000,000. Still, this $200,000 limit is better than no compensation at all.

The claim against the at fault party is called a “tort claim“. The tort claim on behalf of the surviving family members cannot at law be a claim for pain and suffering if those family members were NOT INJURED or did NOT SEE the car accident. The claims of the grieving family members have to be limited at law to Family Law Act Claims for loss of guidance, care and companionship. The immediate grieving family members may also claim an income loss and dependency claim for the income loss to the family unit. These claims can only be advanced where the person who passed away reported an income on their tax returns. If the departed was working for cash and failed to report that income on their tax returns, then you will not be able to recover these damages.linkedin-2-300x300

The second part of the claim is against the deceased’s own insurance company. If the deceased did not have car insurance at the time of the accident, then there are priority rules which need to be followed. Your personal injury lawyer can assist. There are often priority disputes between insurance companies to determine who pays out on claims like these.

These first party claims are called “accident benefit claims“. Fault is not a consideration when determining accident benefit claims. It’s where we get the term “no fault” accident benefit insurance. This is opposite to tort claims where fault or liability needs to be established against the other party in order to prove negligence.

To begin a no fault accident benefits claim, the family will need to report the fatality and motor vehicle accident to the deceased’s insurance company. This is done by way of phone call to a normally a toll free, 24 hour call centre where claims are received and processed. You can find the telephone number of hte claims centre on the pink car insurance slip. If the person was a pedestrian, find out the name of the car insurer for the at fault driver. A quick Google Search for the Ontario Claims Centre will give you the telephone number the call. This is an important first step. Failure to place the call will mean that the claim won’t be open and may jeopardize your ability to make future claims. If you’re more an internet person, here is a list of licensed insurers in Ontario along with their contact information for your reference.

Once the call has been made and processed, the file is then opened and assigned to an insurance adjuster to handle the claim. The insurance adjuster will send you a book of forms to complete in the mail. It’s your job to complete them as best you can. You can get a personal injury lawyer to assist you in completing the forms to make sure that it’s done properly.

The big form for fatality claims in car accident cases is something called the OCF-4 Death and Funeral Benefits Application 

Completing this form lets the insurance company know who the survivors are, along with how much was spent on the Funeral. The accident benefits available for Death and Funeral Benefits are as follows:

$25,000 lump sum to an eligible spouse; $10,000 lump sum to each dependant; maximum $6,000 funeral benefits. 

If you paid an additional optional benefits under this category, those amounts are as follows:

$50,000 lump sum to an eligible spouse; $20,000 lump sum to each dependant; maximum $8,000 funeral benefits.

The money recovered from the accident benefit claim, can be received above and beyond any potential payout in the tort claim and vice versa. So, it’s important for the Plaintiffs making a claim to know that there are potentially two pockets from which to collect when dealing with a fatality claim. This may present as two separate insurers. Or, it can take the form in one insurer but two different adjusters/departments (accident benefit and tort).

Grieving family members can also make their own accident benefit claims for grief counselling, psychological services, or if they need to take time off work or cannot engage in their normal day to day activities, they may be eligible for the income replacement benefit or non earner benefit. It all depends on the facts, circumstances and impact of the fatal motor vehicle accident. In order to access these benefits, the grieving family member will need to open their own accident benefit claim by way of OCF-1 Application for Accident Benefits. This claim also needs to be reported to the insurance company in the normal course.

Got more questions about fatality claims? Feel free to call Goldfinger Injury Lawyers for your free consultation. We will let you know what we think of your case and see if we can assist you. It’s always free to call and chat with one of our personal injury lawyers. We take our cases on a don’t pay unless you win basis.



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