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Understanding Automobile Insurance Optional Benefits under the Statutory Accident Benefits Schedule

What are optional benefits under the Statutory Accident Benefits Schedule:  What are they?  Why are they becoming more important?

When shopping for auto insurance, most people’s first thought is to find coverage that will provide them with the lowest premium possible. Most people assume that when they purchase auto insurance, they are covered should the unthinkable happen. When we meet with clients who have been involved in a motor vehicle accident, we advise them on their entitlement to Statutory Accident Benefits, and one of the questions we ask is, “Did you purchase optional benefits?” The majority of clients have never been told about optional benefits and the additional coverages that they provide. This is unfortunate as optional benefits are becoming more important as amendments are made to the Statutory Accident Benefits Schedule which reduce an insured’s entitlement to benefits under a standard policy. In September of 2010, the government made drastic reductions to the benefits those injured in motor vehicle accidents are entitled to. Most recently, further drastic changes to the benefits available for accident victims were included in the Ontario Budget. Until we get a significant positive change in the Statutory Accident Benefits Schedule, it is important to understand the additional benefits which are an option for you and your family.

Below are some examples of which optional benefits we see in our day to day practice which would make the greatest impact to our clients and their recovery following a motor vehicle accident.[1]

Income Replacement Benefits

Without optional benefits, the maximum amount of weekly income replacement benefits is 70% of an individual’s gross income, to a maximum of $400.00 per week. For many individuals, $400.00 per week is not sufficient to replace the income lost and support a household or family, if he or she is unable to work as a result of injuries sustained in a motor vehicle accident. With optional benefits, this $400.00 per week can be increased to $600.00, $800.00, or $1,000.00 per week.

Housekeeping and Home Maintenance Benefits:

Unless you sustain catastrophic injuries, under the current system, you are not entitled to the $100.00 per week in housekeeping and home maintenance benefits. In our experience, clients who suffer from non-catastrophic injuries and those who have injuries that fall under the Minor Injury Guideline are also in great need of assistance with chores around the house as they recover from their injuries. Optional benefits can be purchased which would allow individuals who fall under the Minor Injury Guidelines and non-catastrophic category access to the $100.00 per week for the first 104 weeks following the motor vehicle accident. Without these benefits, individuals are required to pay out of their own pocket for any additional assistance they require with housekeeping and home maintenance tasks they are no longer able to perform, as a result of the injuries they sustained in the motor vehicle accident.

Medical and Rehabilitation Benefits:

Currently, if your injuries are considered to be within the Minor Injury Guideline, the maximum you are entitled to is $3,500.00. If you sustain a non-catastrophic injury in a motor vehicle accident, you are entitled to $50,000.00 in medical and rehabilitation benefits for 10 years from the date of the accident. In our experience, clients who suffer from concussions, mild brain injuries, or severe orthopaedic injuries exhaust the $50,000.00 in a fairly short period of time, and well before the 10 year limit. These individuals are required to then pay out of pocket for any treatment they require as a result of the motor vehicle accident, unless they can be declared catastrophically impaired. Optional benefits can be purchased to increase this amount to $100,000.00, the amount of benefits everyone who sustained a non-catastrophic injury was entitled to prior to the September 1, 2010, amendments to the Statutory Accident Benefits Schedule. Benefits can also be purchased to increase the maximum of medical and rehabilitation benefits for non-catastrophic impairment to a maximum of $1,100,000.00.

For those with catastrophic injuries, under standard benefits, they are entitled to $1,000,000.00 for medical and rehabilitation benefits for life. Optional benefits are available to increase the amount of medical and rehabilitation benefits available to those catastrophically impaired to $2,000,000.00.

Attendant Care Benefits:

Those who suffer non-catastrophic injuries are currently entitled to $36,000.00 in attendant care benefits for the first two years following the motor vehicle accident, with a maximum of $3,000.00 per month being payable. Optional benefits can be purchased to increase the attendant care benefit for non-catastrophic injuries to $72,000.00.

For those suffering catastrophic injures, they are currently entitled to $1,000,000.00 for attendant care benefits for life, paid at a maximum of $6,000.00 per month. Optional benefits can increase this amount to $2,000,000.00. However, combined medical and rehabilitation and attendant care benefits for this increased amount cannot exceed $3,000,000.00.

When your policy comes up for renewal, consider asking about optional benefits and decide whether purchasing these additional benefits is right for you and your family.

If you or a loved one has been involved in a motor vehicle accident and would like to discuss the benefits you are entitled to, please contact me.

[1] Please see Part VI sections 28 – 30 of the Statutory Accident Benefits Schedule for a complete list of optional benefits which are available.