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Standard accident benefits in Ontario: A comprehensive guide

Understanding your rights and protections under Ontario's accident benefits system

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Car accidents can happen in the blink of an eye. In the time it takes a distracted driver to glance away from their windshield and check a cell phone notification, the lives of unsuspecting motorists and their passengers could be changed forever.

Even the safest, most attentive driver can be hurt in a car accident. That is why all standard auto insurance plans in Ontario are required to include certain forms of coverage.

No one expects to be injured in a car accident, and few people are prepared for how expensive the road to recovery can be. That is why it is important for everyone to understand the coverage included in all standard auto insurance plans. These standard accident benefits could help car accident survivors offset some of their costs after being injured in a collision.

What are standard accident benefits?

In order to ensure that everyone who has been hurt in a motor vehicle accident can receive compensation for certain injury-related expenses, the government of Ontario requires all basic auto insurance policies to include the coverage mandated within the province’s Statutory Accident Benefits Schedule, also referred to as SABS.

The SABS includes a standardized breakdown of the coverage that must be included in all auto insurance plans. The accident benefits that should be available to anyone who has been injured in a motor vehicle collision are no-fault. That means that, even if a driver’s errors of judgment or violation of traffic rules caused the collision to occur, they should still be entitled to accident benefits.

Types of coverage

Depending on the needs of the individual accident victim, they may be entitled to various types of coverage. In accordance with the SABS, all standard auto insurance plans must include provisions for:

  • Medical and rehabilitation benefits
  • Income replacement, non-earner, and caregiver benefits
  • Attendant care benefits
  • Death and funeral benefits
  • And the payment of other expenses

The availability of these benefits is based on the severity of the injuries sustained in the motor vehicle accident, as well as the impacts of those injuries on an accident survivor’s overall quality of life. For example, unless an accident survivor’s injuries meet the threshold of catastrophic impairment (as defined by the SABS), they will likely not be entitled to attendant care benefits.

Who is eligible?

Anyone who has been injured in a motor vehicle accident should be entitled to no-fault accident benefits. This includes drivers, their passengers, motorcycle riders, cyclists, pedestrians, and other road-users. In fact, even people who have been injured in parking lot accidents involving their own motor vehicle may be entitled to accident benefits.

Drivers who have been injured in a motor vehicle accident should also be entitled to insurance coverage even if the other motorist was uninsured at the time of the collision. This is because all auto insurance plans in Ontario require their policyholder to carry uninsured motorist coverage. This coverage should also be available to the victims of hit-and-run accidents if the at-fault driver cannot be identified.

How to file a claim

Filing an accident benefits claim in Ontario involves several steps. If you were involved in an accident, following these specific steps and adhering to the required timelines can be crucial to your claim’s success.

The process of submitting a claim for accident benefits is not always straightforward. It can be confusing, even overwhelming. Assistance from an experienced car accident lawyer could help you ensure that all forms are completely thoroughly and accurately, and that your claim is submitted in accordance with all required deadlines.

In order to file an accident benefits claim, the accident must be reported to your insurance company within 7 days. This report should include important information about the collision, including the date and time at which it occurred, the location, the names of all parties involved, and their licence plate numbers. You will also be required to provide your insurance policy number, the make, model, year, registration and licence plate number of the vehicle you were driving, and – if the accident was reported to the police – the name and badge number of the investigating officer.

After your report has been submitted, your insurance provider will supply you with the forms required to initiate an accident benefits claim. You have only 30 days to complete and submit these forms, and any other medical documentation that might be required.

Your insurance company may request that you attend assessments with healthcare professionals of their choosing. They may also ask you to provide updates on your medical condition, treatment progress, and any changes in your circumstances.

Working with an Ontario car accident lawyer throughout this process can help you make sure all information submitted is accurate and on-time. Doing so may help increase the likelihood of your claim’s approval.

What if your claim is denied?

Unfortunately, insurance companies often find reasons to deny claims for accident benefits. Oftentimes, the reasons they provide for these denials are difficult to comprehend.

One of the most commonly cited reasons for the denial of accident benefits is insufficient medical evidence. In these cases, applicants whose claims have been denied may be able to submit additional supplementary evidence in order to substantiate their claim.

An Ontario car accident lawyer may be able to help you recover the test results, expert opinions, and other medical documentation required to prove the severity of your injuries to your insurance provider. By doing so, they may be able to help you overturn your insurer’s initial decision to deny your claim.

However, there may be other, more complicated reasons for insurance providers to withhold accident benefits or provide unfairly low settlement amounts to injured accident survivors. By working with an Ontario personal injury lawyer, you may be able to appeal the insurer’s unfair determination.

Legal implications

Experienced personal injury lawyers in Ontario should be familiar with the tactics often used by insurance companies to deny the accident benefits claims of deserving policyholders. That is why, after being injured in a motor vehicle accident, it is important to seek legal counsel even before submitting a claim for benefits.

Standard accident benefits can be invaluable resources for the injured survivors of motor vehicle accidents. By providing compensation for various injury-related expenses, this no-fault insurance coverage helps the victims of unexpected, traumatic circumstances feel secure in a time of overwhelming financial loss.

However, accident benefits can only help injured motor vehicle survivors if insurance companies provide them fairly. If your claim was denied or if the amount of benefits you received was unfairly low, consider scheduling a free initial consultation with an Ontario personal injury lawyer to learn about options that may be available to you.

You can contact Preszler Law here.