The actual benefits you are entitled to is dependent upon the facts of your specific case. What follows is a list of potential benefits:

1. Income Benefits
2. Medical and rehabilitation benefits
3. Attendant care benefits
4. Death benefits
5. Other beneftis

Many of these benefits may be increased if you have purchased additional, optional coverage with your auto insurer.

If you have questions about benefits to which you may be entitled. Click here for a FREE LEGAL CASE EVALUATION.

1. Income Benefits

a) Income Replacement Benefits

• If you are unable to work because of injuries sustained in a motor vehicle accident, you may be entitled to Income Replacement Benefits equalling 80% of your net income, to a maximum of $400.00 per week unless optional higher maximum benefits have been purchased.
• The $400 maximum amount will be reduced to $300 for all policies issued or renewed after January 1, 2004.
• The amount of benefit payable will be reduced by amount of other income benefits being received (i.e. short term disability payments).
• Income Replacement Benefits commence one week after a motor vehicle accident that has caused a "substantial inability" to perform the essential tasks of your employment.
• Income Replacement Benefits are payable for up to 104 weeks following the accident.
• In order to receive Income Replacement Benefits beyond 104 weeks, you must prove that you suffer "a complete inability to engage in any employment for which you are reasonably suited by education, training or experience".
• The amount of Income Replacement benefits is reduced automatically after age 65.

b) Non-Earner Benefits

• If you are not employed at the time of the motor vehicle accident, you may be entitled to a non-earner benefit of $185.00 per week.
• Non-earner Benefits become payable 6 months after your motor vehicle accident.
• Individuals under 16 years of age are not entitled to receive Non-earner Benefits.
• Individuals who suffer a complete inability to carry on a normal life as a result of a motor vehicle accident, who were in school at the time of the accident, may be entitled to $320.00 per week.

c) Caregiver Benefits

• If at the time of the accident you resided with a person who required full time care, you may be entitled to a caregiver benefit of up to $250.00 per week, plus $50.00 for each additional person requiring care, if you incur the expense of that care.
  

2. Medical and rehabilitation benefits

• The accident benefits insurer is required to pay for a wide range of medical and rehabilitation expenses over and above what is paid by OHIP, to a maximum of:
• $100,000.00 for up to 10 years - if you suffer a Non-Catastrophic injury.
• $1,000,000.00 over your lifetime - if you suffer a Catastrophic injury.

a) Catastrophic Injury

A Catastrophic Injury is the most serious of the personal injuries. An individual is deemed to have sustained a Catastrophic Injury in circumstances of quadriplegia, paraplegia, amputation of both arms or legs, brain impairment defined by a score of 9 or less on the Glasgow Coma Scale, marked or extreme mental or behavioural impairment, severe disability from brain injury, and where there is impairment to 55% of the person.

b) Non-Catastrophic Injuries

A Non-Catastrophic Injury is a more modest injury than a Catastrophic Injury. A Pre-Approved Framework (PAF) for treatment has been developed for modest injuries which are defined as “WAD I” and “WAD II”.

What is a Pre-Approved Framework ( “PAF”)?

• A Pre-Approved Framework is a set of services for WAD I or WAD II injury for which your insurance company will pay without requiring approval.
• The PAF may also cover other common symptoms including shoulder pain, referred arm pain, dizziness, tinnitus, headache,hearing and memory, and TMJ (jaw pain) as long as they do not require separate treatment from that provided under the PAF.

What is “WAD I”?

• WAD stands for “Whiplash Associated Disorder”.
• A WAD I is an acceleration-deceleration mechanism of energy applied to the neck that results in neck pain, stiffness and/or tenderness. The pain is often minor at first, or entirely absent and may feel like a stretch. In many cases, tenderness or minor swelling will set in a few hours later or the day following the accident.

What is “WAD II”?

• A WAD II is an acceleration-deceleration mechanism of energy applied to the neck that results in neck pain, stiffness or tenderness with musculoskeletal signs including decreased range of motion and point tenderness. A moderate stretching of the tissues and some partial tearing may occur. In significant soft tissue sprains, the symptom onset is immediate, as is pain.

Speak to your doctor or other health care practitioner if you are uncertain about the diagnosis of your injury.

3. Attendant care benefits

• The accident benefits insurer is also required to pay for personal care services that you may require following your accident to a maximum of:
• $72,000.00 ($3,000.00/month) for up to 2 years - if you suffer a non-Catastrophic injury.
• $1,000,000.00 ($6,000.00/month) over your lifetime - if you suffer a Catastrophic injury.

4. Death benefits

If someone is killed in a motor vehicle accident:

• $25,000.00 is payable to the deceased’s spouse.
• $10,000.00 is payable to each of the deceased’s dependants.
• $10,000.00 is payable to a person upon whom the deceased was a dependant.
• Up to $6,000.00 is payable for funeral expenses.

5. Other available benefits

• Expenses of family members and/or those living with the injured person who visit during treatment or recovery. These include meals, mileage, travel expenses and hotel. Please remember to keep your receipts.
• Housekeeping and home maintenance expenses, up to $100.00/week, payable for:
• a maximum of two years of you suffer a non-Catastrophic injury.
• lifetime if you suffer a Catastrophic injury.
• Lost education expenses for students, to a maximum of $15,000.00.