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Getting paid interim benefits after you get hurt or seriously injured in Ontario

There are serious misconceptions of how people get paid, or receive benefits after they’ve been seriously hurt or injured in an accident.

You’ve likely heard stories of insurance companies paying for an accident victim’s lost wages, treatment costs or even getting them a modified vehicle or modified home before their case even settles.

Some of these things might be true. Some of these things might be false.

At the end of the day, it’s this sort of misinformation which creates large scale confusion as to what benefits get paid, and what benefits don’t get paid before a case even settles.

Goldfinger Injury Lawyers would like to set the record straight with this instalment of the Toronto Injury Lawyer Blog.

When you hear that someone is receiving benefits, there are two big questions which need to be asked:

  1. What type of accident was it?
  2. What type of insurance is paying for these benefits

WHAT TYPE OF ACCIDENT CAUSED THE INJURY?

If the accident victim was involved in an assault, slip and fall, dog bite case, long term disability claim or anything else that does NOT involve a motor vehicle; then they cannot claim accident benefits. Accident benefits are interim benefits which cover lost wages (income replacement benefit), attendant care, cost of medical/rehabilitation treatment, housekeeping and home maintenance and will even pay for out of pocket expenses for such things as damaged clothing, prescription medication and even accessible vehicles, ramps or the costs of a wheelchair. These accident benefits are ONLY available to those injured in a motor vehicle accident. If you are involved in an accident which does not involve a motor vehicle, then these benefits are not available to the accident victim. It seems unfair and odd, but that’s just how the law works. Someone can have a mild soft tissue injury to their back and the car insurer will pay for their physio regardless of fault. But someone who slipped and fell and broke their hip will not get their physiotherapy paid for by the at fault defendant until the case has settled (if this head of damages is accounted for in the settlement or judgment).

In Ontario we have a “no fault” system of accident benefits for motor vehicle accidents. That means that regardless of fault, injured accident victims are entitled to claim accident benefits. We do not have a no fault benefit system of slip and fall cases, dog attacks, assault cases etc.

Depending on when your car accident took place you might be entitled to more benefits compared to different years in time. In the past the accident benefits were more generous than they are today. ┬áSo it’s almost as if the type of accident, and the year of the accident is just as important as to the injuries and how the accident itself happened when considering whether or not interim benefits will be paid to the injured accident victim.

WHAT TYPE OF INSURANCE IS PAYING OF THE BENEFITS?

Canada is a free market. Individuals are allowed to purchase the type of insurance they want in order to protect them when they need help the most.

Some people buy insurance which will cover them for virtually any peril or situation. Other people don’t buy insurance at all.

Insurance products can cover a lot of different things. They can cover wage loss in the event you cannot work on account of disability (called short term and long term disability insurance).

Insurance can cover your mortgage payments in the event you can’t pay off your mortgage due to injury or disability (mortgage insurance).

Insurance can cover your medical and non-OHIP related health care expenses (health care insurance).

Insurance can cover the cost of having someone come to your home and help you with cooking, cleaning and helping you with your activities of daily living (called attendant care insurance).

Insurance can pay you a lump sum amount in the event that you loose a limb in an accident or your ability to walk, talk or see (called critical illness insurance).linkedin-2-300x300

But if you have not purchased any insurance, you won’t get these sort of benefits. The reality is that just because one person has purchased some type of insurance and paid premiums out of their pocket does not mean that everyone in the world gets access to these benefits. You have to have purchased coverage in order to receive benefits. This is why it’s important to understand what type of insurance is paying for the benefits because not everyone has access to the same types of insurance benefits. That’s the cold hard truth.

Sometimes private insurance isn’t behind the care and protection of the accident victim. Sometimes it’s the government which intervenes with OHIP funded physiotherapy, or attendant care coverage through the LHIN (formerly CCAC). These benefits aren’t perfect. But they are something; and that something is better than receiving nothing. People who were already receiving benefits from the government BEFORE their accident will continue to receive coverage after their accident. Once the government faucet of benefits has been turned on for accident victims, it’s much easier for those benefits to continue. As opposed to starting fresh and getting benefits from a fresh claim. Meaning that it’s much easier to receive government benefits once you’re in their system as oppose to entering their system with a new claim.

Sometimes employers offer their employees different types of insurance as a perk of employment. We often seen unionized employees with generous collateral benefit packages. If you’re not employed, or an employee without a benefits plan then you won’t have access to these benefits.

So if your neighbour or someone you know is (or is not) receiving benefits and you’re wondering why; you need to ask yourself these two questions:

  1. What type of accident was it?
  2. What type of insurance is paying for these benefits

Once you have the answers to these two questions, you will have a better understanding of why certain people seem to receive benefits before their cases settle, vs. those who appear to receive no benefits at all.

One final note: just because you might be entitled to benefits does NOT GUARANTEE that an insurance company will pay out those benefits. Do you really think that insurance companies get rich simply paying out on every claim which crosses their desk?

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