Motor Vehicle Accident Benefits vs Tort Claims

Accident Benefits and Tort Claims

In Ontario, an injured person can be compensated through two sources, accident benefits and a tort claim. It is important to know the extent of your rights under these legal schemes and what to do when you’ve been injured in a motor vehicle accident.

The first type of benefit is known as Accident Benefits (AB). In Ontario, we are fortunate to have a no- fault insurance regime, which means that these types of benefits can be available to all injured persons regardless of the fault.  You can apply for the benefits through your own automobile insurance policy, or if you do not have a vehicle, through the insurance policy that you are a listed driver of, and if not from the insurance policy, then from any other vehicle involved in the accident. Accident benefits are available to all individuals involved in a motor vehicle accident.

What type of Accident benefits can I receive?

Your benefits can be split into the standard levels benefit and other, optional benefits.

Medical Treatment

Accident benefits from the automobile insurance company can cover all “reasonable and necessary expenses” incurred as a result of the accident. These can include, but are not limited to:

• Costs for medical, surgical, and dental procedures
• Chiropractor, physiotherapist, and psychotherapist fees
• Medication and medical aids

In some cases, transportation costs related to medical treatment sessions and medical assessments may also be covered. Please consult a personal injury lawyer for more information on the maximal allowed rates and expenses that can be claimed.

Benefits are also provided for those who suffer traumatic injuries. These injuries often require a significant amount of ongoing therapy and care to assist with rehabilitation. The goal of rehabilitation is to return the injured person to some semblance of a normal social and work life. Permissible expenses should also be “reasonable and necessary”, and include, but are not limited to, life skills training, family and financial counselling, employment counselling, and vocational or academic training. Home, vehicle and workplace accommodations are also covered under this section.

If you are a driver, passenger, or pedestrian involved in a motor vehicle accident, you may claim:

1. Income replacement benefit: equivalent to 70% of your gross income up to a maximum of $400/ week. The most common type of benefit, this type of benefit essentially compensates you for lost income during the time you miss off work due to injury or recovery. It will cover up to 70% of your gross income up to a maximum of $400 a week. Alternatively, if you were not working you may be eligible to receive non- earner benefits. This benefit compensates you for the loss of daily life functions. Claimants who are completely unable to perform their daily activities, such as housekeeping, shopping, driving, or other activities, as a result of injury can qualify under this section. This benefit is generally limited to $185 a week, lasting for up to two years. There is some variance with respect to the amount you are entitled to, and the duration of the period to which these benefits are paid, so please consult a legal expert.
2. Child care benefit: $250 a week for the first child, and $50 for any additional child (this is an optional benefit, requiring an additional insurance premium to be paid)
   Duration: lasts up to 104 weeks after the accidents unless claimants demonstrate that they suffer from a complete inability to carry on a normal life. There are some exceptions, so please see a lawyer for clarification.These benefits are mutually exclusive, which means that claimants cannot receive child care benefits if they are receiving income replacement or non- earner benefits.
3. Attendant care benefit: up to $3000/ month, and in the case of “catastrophic injury”, up to $6000/ month
   These benefits are related to expenses for hiring an aide to help catastrophically injured victims with their day to day care needs. The benefits can also cover stay in a long term health facility.
4. Rehab benefit: these are the most common of all the benefits available to accident victims
   Claimants are entitled to “reasonable and necessary” medical and rehabilitation treatment in order to help them return to society.
5. Housekeeping benefit: $100/week (optional benefit as well)
   These benefits are available to catastrophically injured claimants. These cover the costs of housekeeping and caretaking needs.
6. Lost educational expense: up to $15000
   These are expenses lost due to not completing a course in elementary, secondary, post- secondary or continuing education, provided that the person was enrolled in the program at the time of the accident.
7. Visitor expenses are benefits that cover travel expenses for certain close relatives to visit the plaintiff.
8. Miscellaneous expenses can also be claimed including damage to clothing, glasses, hearing aids, and other similar expenses for replacing items.
9. Death and funeral expenses are also covered up to $25000 paid to a spouse and $10000 to every qualifying dependant. In addition, funeral benefits up to $6000 are also available under auto policies.

Optional benefits are available to purchase under the SABS. These provide additional benefits to the basic benefits covered, and must have been purchased prior to the accident or injury. Always consult a lawyer to help determine what extent of optional benefits you may be entitled to.

Claiming accident benefits against insurance companies can be an arduous and complicated process. It is important to consult a personal injury lawyer to assist you with the process of filing for accident benefits. At Grillo Law we have over 30 years of experience dealing with such issues and have helped tens of thousands of clients like you recover money for expenses, losses, and treatment.

Tort claim

In many cases, you may be entitled to further compensation in a motor vehicle accident. Beyond the basic insurance benefits, an important aspect of the law is tort damages and recovery.
Torts refer to a wrongful act committed by a party that has resulted in some sort of physical, emotional, or financial injury. Under these circumstances, you may have standing to commence a tort claim against the responsible party for further compensation.

The purpose of a tort claim is to help recover damages to make the victim whole again. As a result, tort law is important for achieving justice for victims and protecting them from social injustices. Tort claims are different from criminal cases!

Intentional vs. Unintentional tort

Another important distinction in tort is the difference between intentional and unintentional offences.
A tort is considered unintentional when the wrongdoer is just careless to the surrounding circumstances, and their failure to take care leads to physical injury for the plaintiff. In these cases, the court would ask whether the person was negligent or not. Motor vehicle accidents, since they are accidental, will fall under this category.

A tort is considered intentional when one party intends to harm or cause injury to the other party. A good example of this would be battery.

It is important to note that just because the wrongdoer did not intend to injure you, it does not prevent you from recovering money to the full extent of the law! Just because it was an accident does not mean that you as a victim should not be compensated! The courts will look at a variety of factors and often case wrongdoers will be found liable because they failed to take the necessary standard of care in their activities.

Consult a lawyer to determine the potential for your tort claim.

The law of torts can be complicated and you may not know the full extent of your entitlement to damages under the law. It is important to contact an experienced lawyer for assistance. At Grillo Law we have over 30 years of experience dealing with motor vehicle accidents and have helped recover compensation for thousands of clients like you.