Everything You Need To Know About Accident Benefits Coverage in Ontario

Find Out More About the Accident Benefits Ontario Drivers Need

Most of us do it at least once daily: We get in our car, start the engine and drive. We may go to work, pick up our kids, get groceries, and even go on a road trip. Driving is part of our daily routine. We often spend little time thinking about our risks and responsibilities while behind the wheel.

In the vast majority of cases, we reach our destinations safely. There are times, however, when automobile accidents do occur. Thankfully, injuries and damages are minor in most accidents, such as with a fender bender. Unfortunately, however, serious motor vehicle accidents do happen, resulting in fatalities and catastrophic injuries.

Ontario law requires every driver to be licensed and each motor vehicle owner to have insurance, including accident benefits. Ontario car insurance through an insurance provider offers coverage for four required protections:

• Third-party liability coverage
• Direct compensation for property damage
• Uninsured automobile
• Accident benefits coverage

Accident benefits coverage protects those injured in accidents. This includes the insured/driver, possibly the passengers, and others, such as pedestrians or passersby. Accident benefits can consist of payments for caregiving, income loss, funerals, and many other expenses. For example, funeral costs in Canada can range from $1,500 to $20,000, depending on preferences. The funeral benefit paid under a standard policy with standard accident benefits is up to $6,000. With increased accident benefits, you can receive coverage of up to $8,000 for funeral expenses.

Our Morison Insurance brokers have created a piece on the types of coverage provided by accident benefits. Ontario policyholders also need to know what increased coverages are available to ensure you and your loved ones are protected in the event of an accident. If you need more information, we invite you to call your knowledgeable Morison Insurance broker today—we’re happy to walk you through the various options. You can rely on us to work tirelessly to find the coverage you need and want for your protection.

What Are Accident Benefits?

Accident benefits coverage is mandatory under the Ontario Auto Policy (Section 4) that protects the insured person, their spouse, their dependants, any passengers in their vehicle and any involved pedestrians or others injured in an automobile accident.

Who Needs Accident Benefits Coverage?

Every motorist/vehicle owner in Ontario must carry auto insurance, and standard accident benefits are included in all auto insurance policies. Accident benefits coverage protects injured persons, their spouses, dependents, and others injured during an accident, such as passengers or passersby, from financial difficulties and expenses involved with treatment, rehabilitation, and everyday living costs. However, the option to increase these accident benefits coverages for additional protection should an incident occur. An insurance broker has the expertise and will walk you through your options to ensure you have the best coverage.

Categories Of Injuries For Accident Benefits

Before we get into the different options offered by accident benefits, Ontario residents should know that accident benefits differ based on the category of injury suffered. There are three categories of injuries for accident benefits: minor injury guidelines, non-catastrophic injuries that are not minor injuries, and catastrophic injuries.

Minor Injury Guideline (MIG) – If the injured insured person suffers sprains, strains, whiplash, contusions, abrasions, lacerations or subluxations.

Non-Catastrophic Injuries that are non-MIG – The injured insured person has injuries outside of the Minor Injury Guideline but does not qualify as a catastrophic loss. The non-catastrophic injury category is sometimes referred to as Serious.

Catastrophic Losses – If the injured insured person suffers paraplegia, tetraplegia, severe impairment of ambulatory mobility of a limb or amputation of a limb, loss of sight, loss of hearing, or brain injuries. A physician or neuropsychologist must complete an OCF19 Application for Catastrophic Loss form.

What Is Covered By Accident Benefits?

Accident benefits will cover lost income, medical and rehabilitation, funerals, and more. It will also cover an insured injured person for travel to and from treatment, ambulatory costs, equipment such as wheelchairs and crutches, damaged clothing from the accident and lost tuition costs for injured students. Other accident benefits coverages include housekeeping and home maintenance, attendant or aide care, and caregiver benefits should the insured injured person qualify.

Increased accident benefits may be purchased to increase the limits of certain benefits of what is offered under the standard mandatory accident benefits coverage. It is important to note that accident benefits coverage is secondary to government health plans, such as OHIP, and private or employee health plans, such as medical treatment, rehabilitation, and short-term or long-term disability.

Income Replacement Benefit (IRB)

This accident benefits coverage is provided if the injured insured person cannot work their regular employment duties. If the insured qualifies, they will be entitled to 70% of their gross weekly income to a maximum of $400 per week. It must be established that they can substantially not perform their employment duties. After two years, the insured person would have to establish that they could not qualify for any employment at your educational or training level.

Increased Coverage Options – An option is to increase the income replacement benefit coverage. The weekly limit can be increased to $600, $800 or $1,000 weekly. It’s a good idea to seriously consider increased coverage for your income replacement benefit, as $400 per week doesn’t necessarily go as far in today’s world as it did a decade or two ago, and you may have additional expenses while you’re recovering from injury and unable to work.

Caregiver Benefit (CGB)

This accident benefits coverage is provided if the injured insured person cannot perform their primary caregiver duties for a dependent such as a child or elderly parent. They can receive reimbursement for incurred expenses for assistance with caregiving duties. The insured would be entitled to $250 per week for the first dependent and $50 per week for any additional dependents. This benefit is only for insureds who suffer a catastrophic loss or if the increased coverage is purchased.

Increased Coverage Options – Under the standard coverage, the caregiver benefit is only available for those suffering catastrophic losses; however, coverage can include minor injuries and non-catastrophic losses.

Medical And Rehabilitation Benefits

Medical and rehabilitation benefits will cover the injured insured for incurred medical expenses and rehabilitation expenses not covered through government or private/employment health plans. These may include prescriptions, physiotherapy, massage or chiropractic sessions, TENS machines, wheelchairs and crutches, and occupational therapy. If you fall under the Minor Injury Guideline (sprains, strains, whiplash, subluxations, contusions, abrasions, lacerations, etc.), you would be entitled to $3,500. If your injuries are not minor but not catastrophic, you would qualify for up to $65K within five years. If your injuries are catastrophic (paraplegia, tetraplegia, impairment of ambulatory mobility or amputation of a limb, loss of vision, brain injuries, etc.), you can qualify for up to $1 million.

Increased Coverage Options – Coverage can be increased to $130,000 for five years post-accident or $1 million for life post-accident. This benefit can be increased for catastrophic losses to $2 million for life post-accident. The optional benefit must be on the policy before the loss occurs. This is another type of increased coverage that should be seriously considered, as the medical cost of rehabilitation can be surprisingly high, and you’ll want the best options available so you can recover quickly and thoroughly and get back to your everyday routines without lingering pain or other impediments.

Death Benefit

Suppose a vehicle collision results in a fatality. In that case, this standard benefit means the surviving spouse of the deceased insured would be entitled to $ 25,000, and the surviving dependants would be entitled to $10,000 each.

Increased Coverage Options – Death Benefits coverage can be increased from the standard $25,000 for the surviving spouse and $10,000 for each surviving dependent to $50,000 for the surviving spouse and $20,000 for each surviving dependent, respectively.

Funeral Benefits

If an accident results in a fatality, this benefit would pay up to $6,000 towards funeral costs.

Increased Coverage Options – To provide additional coverage, funeral benefit coverage can be increased to $8,000.

Tort Deductible Benefit

The tort deductible benefit is a standard amount deducted from a settlement or court award for pain and suffering.

Increased Coverage Options – There is an option to purchase coverage to reduce the standard deductible.

Non-Earner Benefit (NEB)

An injured insured person can qualify for this benefit if there is a complete inability to live a normal life. This standard benefit is a two-year benefit. The insured would be entitled to $185 per week and would begin four weeks after the onset of the complete inability to carry on everyday life.

Attendant Care Benefit

The attendant care benefit is compensation for the cost of an attendant, including their transportation to assist with care needs such as bathing, dressing, accompanying patients to treatment, and more. Insureds under the Minor Injury Guideline do not qualify for this benefit. Non-catastrophic losses can qualify up to $3,000 monthly to a combined limit of $65,000 for medical, rehabilitation, and attendant care within five years. Catastrophic losses can qualify up to $6,000 monthly to a combined lifetime limit of $1 million for medical, rehabilitation, and attendant care.

Housekeeping And Home Maintenance Benefit

The benefit is only available under standard accident benefits coverage for insured who suffer catastrophic losses and pay $100 weekly for professional cleaning services. This benefit can be purchased to be added to minor injuries and non-catastrophic losses.

Are There Additional Accident Benefits Coverage Available?

Dependant care benefits and indexation benefits can be added to your auto insurance policy to provide additional coverage.

Dependant care benefits can be purchased for costs an injured insured person incurs to care for dependents. This benefit can be payable even if the insured qualifies for an income replacement benefit (unlike caregiver benefit, where only one can be selected between IRB and CGB). This benefit pays $75 per week for the first dependent and $25 per week for each additional dependent to a maximum of $150 per week for life.

Indexation benefits will automatically adjust accident benefits according to the Consumer Price Index for Canada.

How Much Does Accident Benefits Coverage Cost?

The cost of accident benefits coverage depends on many factors, including the type of coverage on your automobile policy and if additional or increased coverages are added to your insurance policy. Therefore, a simple breakdown of your accident benefits coverage is nearly impossible due to all the factors.

We recommend speaking to an insurance broker who will get you several auto insurance quotes from insurance companies tailored to your specific needs and explain accident benefits coverages and costs to help you decide what policy is best for you.

Why Do I Have to Use My Primary Benefits First When I Was In a Vehicle at the Time of the Accident?

Suppose you are injured in an auto accident while driving your vehicle. In that case, your first thought may be to turn to your auto insurance provider for accident benefits coverage—if you’re injured in your car, it just makes sense to file a claim on your car insurance, right? That’s why many people are surprised to learn that they must access the accident benefits coverage on their primary insurance and exhaust it before they file a claim on their auto insurance for accident benefits. Ontario policyholders are obligated to use their primary benefits before accessing accident benefits coverage on their auto insurance—it’s a legislated rule.

You can open a file for accident benefits so it’s ready to go when needed. Still, you must contact your primary benefits provider first and exhaust your coverage limit with that insurance provider before moving on to your auto accident benefits coverage. While this may seem counterintuitive initially, it’s a good thing because it gives you added coverage that you may need to aid with your recovery. Of course, you don’t have to navigate the ins and outs of accident benefits coverage by yourself. When the worst happens, and you need to use your insurance coverage, the first step is to call your experienced broker at Morison Insurance and let them guide you through the process of accessing your coverage in the right order so you get the compensation you are entitled to.

What Happens If You Don’t Have Accident Benefits Coverage?

Suppose an injured party, such as a cyclist or pedestrian, does not carry their own automobile insurance policy. In that case, they can claim under any vehicle’s insurance policy involved in the accident. A claim can be made under the Motor Vehicle Accident Claims Fund if no vehicle is identified, such as in a hit-and-run collision. This fund can pay up to the $200,000 legal liability limit in Ontario per accident. The injured party may sue for general and special damages.

Where Can I Get Accident Benefits Coverage?

You can get accident benefits coverage and auto insurance by speaking with our expert brokers at Morison Insurance. We will take the time to explain your insurance coverage, such as accident benefits, including standard, increased, and optional accident benefits coverages, so you can make an informed choice about the level of coverage you want.

Morison Insurance is a family-owned business, and we pride ourselves on treating our clients with the same top-level quality of service that we would want and expect for our own family members. We work for you, not for the insurance companies, and that means you can count on us always to prioritize your best interests. Get started today by filling out the form on our website or calling 1-800-463-8074. We look forward to speaking with you.