What Are Optional Accident Benefits?

Ontario has a comprehensive scheme of mandatory automobile insurance. Accident benefits are an important part of this car insurance. This is especially true if you have experienced personal injury resulting from a car crash. Accident benefits are provided to an injured person from their own auto insurance company. This is regardless of whether or not that person caused the accident. These benefits are known as no-fault benefits. The Statutory Accident Benefits Schedule, also referred to as the SABS, is a document that outlines what is covered under the accident benefits portion of your auto insurance policy.

Each auto insurer must provide a minimum amount of coverage for accident benefits, according to the Insurance Act and the SABS. The minimum amount of coverage, or the standard statutory accident benefits provide coverage up to certain monetary limits. Coverage includes supplementary medical, rehabilitation and attendant care, caregiver, along with death benefits, funeral expenses, non-earner and income replacement benefits. To increase the monetary limits of coverage, an insured can purchase additional, optional accident benefits.

What is Covered By Standard Accident Benefits?

Here is what is covered by the standard accident benefits and what the options are to increase the coverage limits:

Income Replacement, Non-Earner and Caregiver Benefits

Income replacement benefits may be available if you are unable to work as a result of a motor vehicle accident. The standard accident benefits provide income replacement of 70% of your gross income, up to a maximum of $400 per week. This can be increased to provide coverage for a maximum amount of $1,000 per week.

Caregiver benefits may be available if you cannot provide care to a dependent as a result of a motor vehicle accident. The coverage available will cover the cost to hire someone to help you care for the dependent. However, coverage is only applicable to specific injuries. Optional, additional coverage may be purchased that includes all injuries.

Non-earner benefits may be available to you if you do not qualify for an income replacement benefit and are unable to continue on your daily pre-accident life. For example, this benefit is available to students, retirees or those who are otherwise unemployed at the time of the accident. Since June 1, 2016, $185 per week is payable after a four week waiting period to a maximum of two years post-accident.

Medical, Rehabilitation and Attendant Care Benefits

Standard accident benefits provide the following coverage:

  • up to $3,500 for minor injuries;
  • $65,000 for non-catastrophic injuries; and,
  • $1 million for catastrophic injuries.

Optional accident benefits may be purchased to increase coverage. For non-catastrophic injuries the monetary limit is $130,000 and for catastrophic injuries it is $2 million.

Medical and rehabilitation benefits cover the cost of health care and rehabilitation as a result of a motor vehicle accident. This includes:

  • Physiotherapy
  • Occupational therapy
  • Massage therapy
  • Chiropractic care
  • Psychological counselling
  • Prescription medication
  • Other services that are not covered by OHIP or through your extended health care provider (if applicable)

Attendant care benefits cover assistance in your home or healthcare facility to help you recover from a serious injury. For example, this would cover the cost of a private nurse or personal support worker.

Housekeeping and Home Maintenance

Under the standard accident benefits scheme, this benefit is only available to those who are catastrophically impaired. The maximum amount of coverage is $100 per week to cover the cost of housekeeping and maintenance expenses incurred while you recover. Optional benefits may be purchased to provide coverage of this benefit for non-catastrophic injuries.

Death and Funeral Benefits

In the event that you pass away as a result of a motor vehicle accident, the following benefits will be paid out:

  • $25,000 to your spouse (which can be increased to $50,000)
  • $10,000 to each of your dependents (which can be increased to $20,000)
  • A maximum of $6,000 for funeral expenses (which can be increased to $8,000)

Other Expenses

The following additional expenses may also be covered by your standard accident benefits coverage:

  • Lost educational expenses: Compensation for lost tuition, books and other education related expenses up to $15,000.
  • Expenses of visitors:  Reasonable expenses incurred by family and friends to visit you during recovery and treatments. Your spouse, children, grandchildren, parents, grandparents, siblings, certain other dependants, and guardians qualify.
  • Damage to clothing, glasses, and other belongings:Receive compensation for damaged clothing, glasses and other personal medical devices damaged during the accident.
  • Cost of examinations: Compensation for the cost of examinations related to treatments as part of your recovery from an accident.

You also have to option to add coverage for a dependent care benefit, which will cover up to $75 per week for your first dependent and $25 for each additional dependent. This benefit can only be claimed if you were employed at the time of the accident and have to pay for additional childcare expenses due to the injuries you sustained in a motor vehicle accident.

You can also add an indexation benefit, which gives you an annual adjustment for inflation for accident benefits. Adjustments are done in accordance with the Consumer Price Index of Canada.

For Optional Accident Benefits, the Cost Pales Compared to the Potential Expenses

As you would expect, there is a cost to purchase optional accident benefits. However, this cost pales in comparison to the expenses that you might incur if you are injured in a motor vehicle accident. In particular, the limits for standard medical, rehabilitation and attendant care benefits for non-catastrophic injuries are typically exhausted fairly quickly. Generally, you must wait two years from the date of the accident before you can apply for catastrophic impairment coverage – meaning that you only have $65,000 available to you for the first two years after an accident to cover all your health care, rehabilitation and attendant care needs.

It is important to speak to your insurance broker and your lawyer about purchasing optional benefits as part of your auto insurance package.

Additionally, if you have been injured in an accident, please contact a lawyer to see what compensation you might be entitled to.

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