Accident Benefits Claims

All standard automobile insurance policies in Ontario have included statutory accident benefits coverage since the early-mid 1990s.

Generally speaking, a victim of an auto accident is entitled to claim for accident benefits even if they were at-fault for the accident. These benefits may include, but are not limited to:

• Income Replacement Benefits;
• Non-earner Benefits;
• Attendant Care Benefits
• Medical and Rehabilitation Benefits;
• Caregiver Benefits;
• Death and Funeral Expenses;
• Housekeeping and Home maintenance Expenses;
• Lost Educational Expenses; and
• Expenses to reimburse damage to clothing, glasses, etc.

Even with these statutory rights, you will need the assistance of a qualified Lawyer or Paralegal to properly navigate the complicated accident benefits scheme. With their help, you can ensure that you obtain all of the benefits that you may be entitled to.

While some auto accident victims may hold the mistaken belief that claiming for accident benefits is a simple process, this cannot be further from the truth. The legislation is complex and the case law is constantly evolving within this area. Disputes arising between the applicant and insurer often wind up being litigated before the Licence and Appeal Tribunal (LAT).

It is important to confirm with your lawyer or paralegal which statutory benefits you may be entitled to under the circumstances and specific terms of your Ontario automobile insurance policy.

Critical timelines

If you have been involved in a motor vehicle accident and intend to pursue a personal injury claim, you should take immediate action. Note that there are deadlines to prepare your accident benefits claim and file it. There are critical timelines that you must adhere to. These include:

• You have up until 7 days to notify your insurance service provider of your plan to seek accident benefits.
• Also, you have a maximum of 30 days to prepare and submit your OCF-1 and ABAP (Accident Benefits Application Package).
• The insurer will demand a reasonable explanation if you fail to act within the appropriate timelines.

Although the scope of this article is focused on accident benefits claims, note that there are deadlines when it comes to pursuing a tort claim against the at-fault motorist. These include:

• Notifying the at-fault party of your intention to sue within 120 days, or your claim for pre-judgment interest and costs may be prejudiced; and
• Ontario’s Limitations Act, prescribes that no claim shall be brought before the 2-year anniversary of the date where the claimant sustained or ought to have known that they sustained, damages as a result of the negligence of others. In most cases, the limitation period will expire on the two year anniversary of the date of the motor vehicle accident. There are some limited exceptions, which should be discussed directly with your lawyer.

Seek legal help

Many victims of road accidents who are not represented by a lawyer fall victim to the strict limitation periods. Failure to notify your insurer of your intent to file a claim or filing it late could jeopardize your chances of getting the compensation you deserve. If these critical timelines are missed, the result will likely be an inability to be compensated.

It is in your best interests to hire a qualified personal injury lawyer. They can best explain the nuances of the law with respect to statutory accident benefits, tort, and the applicable limitation periods. The system is complicated and the insurers are adamant to deny compensation and maximize their own profits. Retaining the services of a competent lawyer helps you build a strong claim right from the outset, gather all of the right pieces of evidence, and receive the proper advocacy and legal advice that you deserve.