Statutory Accident Benefits (SABs) are an important part of Ontario’s auto insurance system, providing essential financial support to those injured in motor vehicle accidents, regardless of fault. These benefits are available under the Statutory Accident Benefits Schedule (SABS), which is regulated by Ontario’s Insurance Act.
Here’s what you need to know about Statutory Accident Benefits (SABS):
What Are Statutory Accident Benefits?
Statutory Accident Benefits (SABs) provide financial support to anyone injured in a motor vehicle accident in Ontario, regardless of who was at fault. These benefits cover a range of needs, from income replacement to medical expenses, ensuring that injured parties can access the care they need and compensate for lost income.
Key Benefits Covered Under Statutory Accident Benefits :
- Income Replacement Benefit (IRB):
- If you are unable to work due to your injuries, you may qualify for Income Replacement Benefits. This benefit provides 70% of your gross weekly income, up to a maximum of $400 per week (higher coverage can be purchased).
- The benefit begins after the first 7 days of your injury.
- Medical and Rehabilitation Benefits:
- This covers the costs of medical and rehabilitation services not covered by OHIP, such as physiotherapy, chiropractic treatment, massage therapy, and occupational therapy.
- Coverage is up to $65,000 for medical and rehabilitation expenses for non-catastrophic injuries and up to $1,000,000 for catastrophic injuries.
- Attendant Care Benefits:
- If you require assistance with personal care due to your injuries (e.g., dressing, bathing), attendant care benefits may cover the costs of hiring a caregiver.
- Benefits provide up to $3,000 per month for non-catastrophic injuries and up to $6,000 per month for catastrophic injuries.
- Caregiver Benefits:
- For those who are the primary caregivers to dependents and are unable to continue due to their injuries, SABs may cover the cost of a caregiver to take over those responsibilities.
- Benefits provide up to $250 per week for the first dependent, plus $50 for each additional dependent (only available in catastrophic injury cases).
- Non-Earner Benefits:
- If you were not working at the time of the accident and cannot live your normal life due to your injuries, non-earner benefits provide financial compensation.
- The benefit is $185 per week and begins after 4 weeks of being unable to lead a normal life. It increases to $320 per week if you were a student at the time of the accident.
- Housekeeping and Home Maintenance Benefits:
- If your injuries prevent you from performing regular housekeeping or home maintenance tasks, you may be eligible for up to $100 per week to cover the cost of hiring help (available for catastrophic injuries only).
- Death and Funeral Benefits:
- In the unfortunate event of a fatal accident, SABs provide death benefits to surviving dependents, including $25,000 to a surviving spouse and $10,000 to each dependent child.
- Funeral benefits cover up to $6,000 for funeral and related expenses.
- Dependent Care Benefits:
- If your injuries prevent you from caring for your dependents, this benefit can cover the expenses of hiring someone to take over those responsibilities. This benefit is only available if you were employed at the time of the accident and are now unable to work.
How to Apply for SABS:
- Notify Your Insurance Company:
- After the accident, contact your auto insurance provider as soon as possible. You typically need to notify them within 7 days of the accident, or as soon as is reasonably possible.
- Complete the Application for Accident Benefits (OCF Forms):
- Your insurance company will provide you with the necessary forms, including the OCF-1 (Application for Accident Benefits) and others that might be required depending on your situation (e.g., OCF-3 for Disability Certificate, OCF-2 for Employer’s Confirmation of Income).
- Submit Supporting Medical Documentation:
- You may be required to submit medical reports, doctor’s notes, or other documentation to support your claim for benefits.
What to Do If Your Claim Is Denied:
If your insurance company denies your claim for accident benefits, you have options:
- Negotiation:
- You can negotiate directly with the insurance company or through a legal representative (such as a paralegal or lawyer) to reach a fair settlement.
- Dispute Resolution:
- If negotiation fails, you can file a dispute with the License Appeal Tribunal (LAT), which handles accident benefit disputes. The LAT can decide on issues related to denied or disputed benefits.
- Legal Representation:
- You can seek the help of a paralegal or lawyer who is experienced in Statutory Accident Benefits claims to assist you with the appeals process and advocate on your behalf.
What to Remember:
- Time is of the essence when applying for Statutory Accident Benefits. Notify your insurer and submit your forms as soon as possible.
- Keep detailed records of all medical treatments, expenses, and communications with your insurance company to support your claim.
- Consider seeking legal advice if you’re unsure about the process or if your claim is denied.
Statutory Accident Benefits are designed to provide you with financial and medical support when you need it most after a car accident. Understanding your rights and benefits under the Statutory Accident Benefits Schedule (SABS) can ensure you receive the care and compensation you’re entitled to.
If you need assistance with your claim or representation at the License Appeal Tribunal, consider contacting a legal professional, such as a licensed paralegal, who can guide you through the process and advocate for your rights.