The Greater Toronto Area has one of the busiest roadways in Ontario. Regardless of having significant highway safety enforcement, KNS Legal Services still see many reckless, negligent, and distracted drivers around us. Involving in a motor vehicle accident claims can have serious implications on one's life. In a case of injuries, you may have to take time off from work and seek medical treatment, which is covered by your own insurance company regardless of you were at fault or not at fault. There are two aspects of a motor vehicle accident claims fund: (1) The Third Party Claim; and (2) The Statutory Accident Benefits Claim. Under the Third Party Claim, an individual has the right to claim damages, either non-pecuniary or pecuniary, from the negligent party(ies), meaning that individual at fault for the accident may be responsible for the damages, if the accident resulted in a death or if the injuries meet the threshold under the law of permanent and serious impairment of an important physical, mental or psychological function, or permanent disfigurement (i.e. scarring).
If the threshold is met, there is a statutory deductible from the amount of damages you would otherwise receive. The amount of deductible depends on when the accident happened. Your family members also have a right to sue under the Family Law Act for the loss of care, guidance, and companionship of the person involved and injured in the accident. Such claims are also subject to a deductible depending on when the accident or death happened. The Third-Party Claim, also known as Tort Claim can only be litigated by a lawyer, but Statutory Accident Benefits Claim falls within the scope of paralegal work. Under the Statutory Accident Benefits Claim, you are entitled to a number of benefits ranging from income replacement benefits, housekeeping benefits, etc.
Entitlement to benefits are given through the motor vehicle insurer of the vehicle, either your own or the individual at fault for the accident, depending on the circumstances as to whether you were a pedestrian at the time of the accident, you were the owner of the vehicle you were driving, etc. If you have been injured. Motor vehicle accident claims fund, then you can be entitled to accident benefits which may cover your medical, income, and visitation expenses in some cases. A brief description of the various benefits available to an injured party is as follows:
Every automobile insurance policy contains a mandatory accident benefits coverage. A list of available benefits is set out in the Statutory Accident Benefits Schedule - Accidents On or After October 1, 2003, and September 1, 2010. Pedestrians, drivers, and passengers of vehicles are entitled to accident benefits. Accident Benefits are after you have applied for them. You must make an application within 30 days of your accident. Most insurers, however, will accept later applications if there is a reason for the delay. You and any member of your immediate family may also be entitled to recover benefits if he or she suffers psychological or mental injury as a result of your accident. If you have private insurance, Statutory Accident Benefits only pays for losses that are not covered by your other private policy or employment benefits plan. If these other benefits plans cover only part of the expenses, Statutory Accident Benefits may pay the balance.
The insurer may be required to pay all of the reasonable expenses incurred as a result of your accident, including a) Medical, hospital, and nursing care, b) Chiropractic, psychological, and occupational therapy c) Medication, prescription eyewear, dental devices, and medical aids, d) Transportation to and from treatment sessions e) Social and vocational rehabilitation f) Home renovations and vehicle modifications. You are entitled to receive up to $50,000.00 of medical and rehabilitation benefits for expenses incurred up to 10 years after the accident if you are not under the Minor Injury Guideline (MIG). If you are in the MIG, you are entitled to $3,500.00. If Your injury is catastrophic, you are entitled to $1,000,000.00 for expenses incurred over your entire lifetime.
If the claimant was employed at the time of the accident and as a result of his or her injuries suffers from a substantial inability to perform the essential tasks of his or her employment may be eligible to Income Replacement Benefits. Those who were employed or self-employed at the time of the accident or at least worked 26 weeks during the 52 weeks prior to the accident and have suffered a substantial inability to perform the duties of their per-accident work could be entitled to Income Replacement Benefits. The calculation of Income Replacement Benefits is as follows:
70% of your after-tax income from your employment, but not exceeding $400.00 net per week
For example, if you received $1,000.00 per week before tax, you would be entitled to receive up to $700.00 gross per week. This means that the automobile insurer would pay you $400.00 net per week. If you have purchased optional benefits when you purchased your auto insurance, you could be entitled to up to $600, $800 or $1,000 per week. However, if you had any insurance coverage from your employer then it must be used first and any difference to get $700.00 per week would be paid by the automobile.
If you were not employed prior to the accident, you may be eligible for Non-Earner. The non-earner benefit could start four weeks after the date of the accident if you suffer a complete inability to carry on with your normal life activities. This is a very onerous legal test that a claimant must meet in order to become eligible for the non-earner benefits. If you are eligible, you may receive up to $185.00 per week.
Caregiver benefits are available to those who had purchased optional caregiver, housekeeping, and home maintenance benefits at the time of purchasing their policy. The Caregiver Benefits are paid up to $250.00 per week for the first person in need of care and $50.00 per week for each additional person in need of care. You CANNOT receive income replacement benefits, non-earner benefits, and caregiver benefits at the same time.
If you have purchased optional benefits and if you have injured in an accident your insurer may be required to pay the cost of providing for an aide or attendant. These benefits include the services of one of your family members caring for you at home. You can receive up to $3,000.00 per month in attendant care for 2 years. If your injury is catastrophic, you can receive up to $6,000.00 per month to a maximum of $1,000,000.00 and there is no time limit.
If your family members and other individuals who were living with you at the time of your accident visit you, they are entitled to payment of all reasonable and necessary visiting expenses incurred as a result of the accident during your treatment or recovery. There is no payment after 104 weeks unless the injury is catastrophic.
If you are unable to continue in a program that you were enrolled in at the time of the accident, the insurer will pay for lost educational expenses. The maximum amount you can receive is $15,000.00. This amount is meant to compensate for expenses incurred before the accident, such as tuition, books, equipment, and room and board.
If you purchased optional benefits, you can receive a maximum amount of $100.00 per week for all reasonable expenses for housekeeping and home maintenance, if you suffer a substantial inability to perform these services and you performed these services before the accident. Your housekeeping and home maintenance benefits are paid for 104 weeks unless the injury is catastrophic.
Your insurer may be obligated to replace or repair clothing damaged in the accident, prescription eyewear, dentures, hearing aids, prostheses, and other medical or dental devices lost or damaged in the accident.