Optional Motor Vehicle Insurance Benefits: Do You Need Them?

The short answer is yes; you should purchase optional insurance benefits. Optional benefits provide an additional level of motor vehicle accident insurance coverage in the event that you are involved in a motor vehicle accident, regardless of whether or not you are at fault for that accident. In particular, individuals should consider purchasing optional insurance benefits for loss of income, caregiver, housekeeping and home maintenance, medical and rehabilitation, and attendant care.

Imagine this: you’re T-boned at an intersection and you shatter your femur. You require surgery and have multiple screws affixed to your bones. During your recovery, you will need physiotherapy, occupational therapy and massage therapy to help rehabilitate you. You are a construction worker, so you cannot work until you are completely healed, if ever. You may have a tort claim, meaning you have a claim against the driver that T-boned you which will allow you to sue for damages, including loss of income and health care expenses. But, it could be a few years before you see any money from that lawsuit. What do you do in the interim? How do you pay for your treatment? How do you continue to make your rent or mortgage payments? Accident benefits help fill in that time gap for those who have sustained injuries in a motor vehicle accident. In particular, you may be entitled to accident benefits from your own insurer for such things as loss of income benefits, medical and rehabilitation benefits, and attendant care benefits.

The loss of income benefit is payable up to $400.00 per week if optional benefits are not purchased. Typically, this benefit is calculated based on 70% of the gross weekly income that you earned in the 52 weeks prior to the accident, and is payable up to age 65, so long as there is a continuing loss of income resulting from the accident. Optional benefits can be purchased to increase the maximum amount paid per week from $400.00 to $600.00, $800.00 or $1,000.00.

Caregiver, housekeeping and home maintenance benefits are not payable unless either you purchased the optional benefit or you sustain a “catastrophic impairment” as defined in section 3(2) of the Statutory Accident Benefits Schedule (the “SABS”).

Medical and rehabilitation benefits are payable for such treatment as physiotherapy, occupational therapy, massage therapy, chiropractic treatment, prescription medication, etc. The amount of the benefit payable depends upon the seriousness of your injury. An injury that falls within the Minor Injury Guideline (such as a sprain or strain, etc.) will only provide benefits up to $3,500.00. An injury that falls outside the Minor Injury Guideline will provide benefits up to $50,000.00. If you fall within the definition of a “catastrophic impairment”, however, then you are entitled to up to $1 million in medical and rehabilitation benefits. These monetary limits apply unless you purchase optional benefits. While $50,000.00 for serious injuries and $1 million for catastrophic injuries may seem like a lot of money, it may not be sufficient for long term care.

Optional benefits can be purchased to increase the maximum amount payable for medical and rehabilitation benefits for non-catastrophic injuries from $50,000.00 to $1.1 million. For catastrophic impairments, an optional benefit can be purchased to provide coverage for medical and rehabilitation benefits of up to $2 million. 

Attendant care benefits cover expenses that are incurred by you or on your behalf as a result of the accident for services provided by an aid, an attendant or by a long-term care facility. For example, this would include the services of a nurse or personal support worker. Attendant care benefits can also cover transportation expenses in certain situations. The maximum payable for a non-catastrophic impairment is $3,000.00 per month to a maximum of $36,000.00. The maximum payable for a catastrophic impairment is $6,000.00 per month to a maximum of $1 million. However, you can purchase an optional benefit that covers up to $1,072,000.00 for attendant care benefits for non-catastrophic impairments and up to $2 million for catastrophic impairments.

As of June 1, 2016 though, the above amounts will be amended such that without optional benefits, those outside of the Minor Injury Guideline can only receive a cumulative maximum of $65,000.00 for medical and rehabilitation benefits AND attendant care benefits. For catastrophic impairments, the maximum payable for medical and rehabilitation benefits AND attendant care benefits is $1 million. The monthly maximums for attendant care benefits of $3,000.00 for non-catastrophic impairments and $6,000.00 for catastrophic impairments still applies, despite the fact that the overall total for attendant care benefits has been reduced.

Moreover, the new SABS legislation will reduce the duration for which benefits are payable. Instead of medical and rehabilitation benefits for non-catastrophic injuries being payable for 10 years, as of June 1, 2016, they will only be payable for 260 weeks post-accident (assuming you are over 18 years old at the time of the accident). The payment duration of attendant care benefits for non-catastrophic injuries has increased, however, from 104 weeks to 260 weeks (again assuming you are over 18 years old at the time of the accident). 

However, optional benefits after June 1, 2016, may be purchased for medical, rehabilitation and attendant care benefits up to $1.1 million for non-catastrophic impairments and up to $2 million for catastrophic impairments with no time limits for which the expenses are to be paid by your insurer. Other optional benefits are also available but were not discussed in this article including: death benefits, indexation benefits, and dependent care benefits.

As a personal injury lawyer, I often see clients that have sustained non-catastrophic injuries that spend the maximum of their medical and rehabilitation benefits in a very short period of time. Depending on the treatment and rehabilitation you require, you can easily spend the $50,000.00 limit in less than 2 years. Further, if you require a full-time attendant care, that $36,000.00 limit may not be sufficient to meet your needs. We recommend that our clients speak with their insurers and/or insurance brokers and purchase optional benefits to increase the coverage that is available to them should they be injured in a motor vehicle accident – whether catastrophically injured or not.

Victoria Boddy is an Associate with the law firm of Howard Yegendorf & Associates.  Victoria can be reached at 613-237-5000 ext. 240 or vboddy@yegendorf.com. For more information about Victoria, please visit www.yegendorflawfirm.ca.

Disclaimer and Cautionary Note

The foregoing provides only an overview and does not constitute legal advice or establish a lawyer-client relationship with the authors or BrazeauSeller.LLP. Readers are cautioned against making any decisions based on this material alone. Rather, specific legal advice should be obtained from a qualified lawyer.