Ontario has a no-fault accident benefits scheme, which compensates you immediately for certain losses. These benefits are automatically available to anyone injured in a car accident – you do not have to show someone else was at fault for the accident. Even if you were a pedestrian in an accident, and did not have your own car insurance, you would still be eligible to receive accident benefits.

The accident benefits scheme in Ontario changes fairly regularly, either through caselaw or legislative changes. However, generally speaking, anyone injured in a car accident can make the following claims for accident benefits. Please note that this list is not meant to be exhaustive, and is merely illustrating some of the more common benefits injured persons regularly apply for. You may be eligible for other benefits. It is best to contact a personal injury lawyer to discuss your particular situation.

Medical, Rehabilitation, and Attendant Care Benefits

These benefits pay for any physiotherapy, massage therapy, or chiropractic treatment you may need after an accident. They also would pay for an aide to provide attendant care should you become unable to care for yourself as a result of the accident. There are three tiers of these benefits, separated according to the seriousness of your injuries, as well as the monetary limits available to injured parties under each tier.

The first tier is the Minor Injury Guideline. This tier deals with minor sprains and strains, and has a limit of $3500.00 for medical and rehabilitation benefits. Attendant care is not available if your injuries are minor in nature.

If your injuries are not minor in nature, your claim is handled in tier 2, the non-MIG, non-CAT tier. These claims are where injuries are more than minor, but not major enough to be catastrophic. Attendant care benefits are available to you, should you need the assistance of someone to complete your activities of daily living. The limit to medical, rehabilitation, and attendant care benefits in $65,000 under this tier.

The third tier for accident benefits in reserved for the very seriously injured parties. This tier manages claims for individuals that are catastrophically injured. These individuals usually have very serious physical and/or psychological injuries. The limit under this tier for medical, rehabilitation, and attendant care benefits is $1,000,000.

Income Replacement, Non-Earner, or Caregiver Benefits
The income replacement, non-earner, and care-giver benefits provide injured person a weekly monetary benefit to compensate them for their injuries. To be eligible for the income replacement benefits (IRBs), a person must have been employed at the time of the accident. If an injured person was not employed at the time of the accident, they can still be eligible if they were employed for at-least 26 weeks in the 52 weeks before the accident or were receiving EI benefits at the time of the accident. Further, the injured person must suffer from a substantial inability to perform the essential tasks of his/her employment. After 2 years, the person must suffer from a complete inability to engage in any employment or self-employment for which he or she is reasonably suited by education, training, or experience, in order to continue to receive IRBs. The amount of this benefit is dependent on your pre-accident income, as well as your policy stipulations. For most people, this benefit would provide them $400 per week, subject to their pre-accident income.

The non-earner benefit is available to those persons who suffer a complete inability to carry on a normal life as a result of their accident, and are not eligible for the income replacement benefit. The amount of this benefit is $185 per week. It is payable for 2 years, unless the person is catastrophically injured.

The caregiver benefit is available to those who suffer a catastrophic impairment as a result of an accident and were the primary caregiver for a person in need of care. The injured person must not have received any compensation for their caregiving activities. This benefit will pay for reasonable and necessary expenses incurred due to caring for the person in need of care, up to $250 per week for the first person in need of care, and $50 a week for each additional person in need of care.

If you end up having a dispute with your insurance company over the payment of certain benefits, and are unable to resolve such disputes, you may apply to the License Appeals Tribunals to have adjudicator decide whether you are eligible for the benefits you have applied for. You must apply within two years from the date of denial of your particular benefit.