In Ontario, anyone injured in a motor vehicle accident may be able to claim various benefits under the Statutory Accident Benefits Schedule (SABS). The purpose of the SABS is to provide insured individuals with access to necessary treatment and benefits in a timely manner. Our firm has previously discussed the different accident benefits available to help injured crash victims with the recovery process. These benefits include medical and rehabilitation, attendant care, income replacement and caregiver benefits.
However, there are several things you may not know about Ontario’s accident benefits. Did you know that some exclusions exist? These exclusions may limit a claimant’s rights and ability to receive certain benefits. It is important to be aware of what may or may not be covered to protect your best interests.
If you have been involved in a crash, a member of our legal team is ready to review your situation and discuss your potential legal options. The initial consultation is free of charge with no obligation involved.
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Accident Benefits Issued Regardless of Fault
Accident benefits are provided by law under every Ontario auto insurance policy. In the event of a crash, you would need to file a claim through your own insurance company. These benefits provide compensation, regardless of fault, to you, your passengers and anyone else injured due to the crash.
Even if you are partially or fully responsible for what happened, you may still be eligible to receive compensation if you suffered injuries. Accident benefits could help cover the following:
- Medical expenses incurred to care and treat your injury
- Rehabilitation services to help improve your condition
- Income from work you cannot earn while recovering
- Cost of hiring an attendant to help with daily tasks
- Cost of hiring someone to take care of your home
Accident Benefits Cover More Than Just Drivers and Passengers
Accident benefits cover anyone injured in a crash with a motor vehicle.
For instance, pedestrians and bicyclists may be able to claim compensation from their insurers. Many pedestrians and bicyclists are unaware that their own auto insurance policy applies, even though they were not driving or riding in a vehicle at the time of the crash.
What if a pedestrian or bicyclist does not have their own auto insurance policy or are not listed on someone else’s policy? They may still be able to receive no-fault accident benefits from the insurance policy of the vehicle that hit them or from the motor vehicle accident claims fund.
Immediate family members may also qualify for accident benefits even if they were not involved in the crash. These benefits could cover treatment for loved ones who experience mental or psychological injury as a result of a crash. Some spouses and/or parents of crash victims may need counseling to help them deal with the emotional trauma that arises out of the injuries their loved one has sustained.
If a loved one passes away in a crash, the spouse of the deceased or anyone who was financially dependent on the deceased may be eligible to receive compensation to cover funeral-related expenses.
Accident Benefits Are Not Automatically Paid After a Crash
Crash victims often assume that accident benefits will automatically start after a crash. However, there are certain steps you must take in order to potentially be issued these benefits.
First, you are obligated to inform your insurer within seven days of the crash should you intend to apply for accident benefits. The insurance company will give you the necessary application forms. You then have 30 days to complete and submit the application forms or risk your claim being denied.
When Crash Victims May Be Ineligible to Receive Accident Benefits
There are certain situations that may make you ineligible to receive accident benefits. For instance, if you knew or should have reasonably known that you were driving a vehicle without valid insurance.
Other situations include:
- Driving without a valid driver’s license
- Driving a vehicle without the owner’s explicit consent
- Driving while specifically excluded from an auto policy
- Driving a vehicle while committing a crime
A crash victim who knowingly misrepresented information when he or she applied for auto insurance will also be grounds for disqualification. This includes passengers who knew or should have reasonably known that the driver was operating the vehicle without consent from the owner of the vehicle.
Disputing a Refusal or Termination of Accident Benefits
If your insurance company has denied you accident benefits, you have one of two options. You may be able to resubmit your application under certain conditions or dispute a denial of your claim.
If you end up in a dispute with your insurance company, you will need to appeal the decision before the License Appeal Tribunal (LAT). The application must be filed within two years of the insurer’s refusal.
Generally, a case conference will be held where an adjudicator tries to resolve the dispute by mediation. If there is no resolution, both parties will proceed to a hearing. This is why having an experienced lawyer by your side is beneficial. He or she can help you navigate this process to get you the benefits you need.
Call Greg Monforton & Partners for Trusted Legal Help
If you need legal help after a crash, Greg Monforton & Partners is ready to assist. We have a proven track record, obtaining millions in compensation on behalf of our clients, including car crash victims.
The initial consultation with a licensed car crash lawyer in Windsor comes at no cost or obligation to you. We charge nothing up front to retain our services.
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