Accident Benefit Claims & Tort Claims

If you have been injured in an auto collision in Ontario, you may have two claims:  Accident Benefit Claim and a Tort Claim.

accident benefit claim

The first claim is an accident benefit claim. Accident benefits are referred to as “ABs” in the industry. Your own car insurance company is responsible for paying your accident benefits. This is the very nature of “no fault” insurance. Regardless of whose fault the car accident is, your own insurer pays for accident benefits.

Accident benefits cover:

• Medical and Rehabilitative benefits not covered by OHIP (physio, massage, chiropractic, counselling)
• Attendant Care Benefits (someone to help you cook, clean, bathe, personal care for the injured)
• Income Replacement ($400/week) OR Non-Earner Benefits ($185/week)
• Death/Funeral Benefits if someone died in the car accident
• Out of pocket expenses (cost of medication, assistive devices, hospital parking, transportation to/from medical appointments greater than 50km)

The limits for these accident benefits are constantly changing. You can opt to purchase additional accident benefit coverage to increase those limits, but very few opt to do so.

In addition, the government is constantly tinkering with these benefits to try to keep premiums down. The reality is that all this tinkering really does is decrease the operating costs of insurers so that they can maximize their profits. Hence, Ontario drivers are paying MORE, but getting LESS from their car insurance.

Part two of your auto collision case is called the “tort claim“.  This is where your lawyer sues the ‘at fault driver”.

What is claimable in a Tort lawsuit against the at-fault party?

1. Wage loss and/or loss of opportunity to earn income either in the past or the future as a result of your injuries;
2. Treatment/medical expenses you incur as a result of your injuries are recoverable through a Tort claim;
3. Special damages which include mileage and parking expenses that you incur in order to obtain treatment;
4. Housekeeping expenses that you incur as result of your car accident related injuries;
5. Pain and Suffering amounts are determined by what Judges have awarded in other cases similar to yours and incorporate variables such as the extent of your injury, how it has affected your life/how it will continue to affect your life and the treatment you were required to receive.

It is important to be aware of your legal rights and entitlements available to you as a result of an auto collision as the decision whether or not to pursue these entitlements can drastically affect your life. There are time limitations to these claims so it’s important to obtain legal advice as soon as possible following your collision.

The advice and information contained in this article are for educational purposes only and is not intended to replace a lawyer’s advice. Please always consult with a lawyer to understand your legal rights.

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