Motor Vehicle Accident (MVA) Benefits

Accident Benefits are the benefits provided by your own auto insurer if you have been in a car accident.
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These benefits are commonly known as “no-fault” benefits because you are entitled to them regardless of whether or not you are at fault for the accident. Such benefits are intended to provide a basic level of compensation. The benefits available are mandated by the Ontario government under the Insurance Act, and the Regulations under the Act, which set out the Statutory Accident Benefits Schedule.

What am I entitled to receive?

Entitlement to accident benefits will depend on your individual circumstances as well as the exact date of your accident. This is because changes in auto insurance are common, and these changes affect available limits, entitlements, and deductibles. Effective September 1, 2010, several changes to the Statutory Accident Benefits Schedule will result in reduced benefits in several categories unless optional coverage has been purchased. You should consult with a lawyer to determine which benefits apply to your situation.

Income Replacement Benefits

If you were working at the time of the accident or had been working most of the year leading up to your accident, you are likely entitled to receive weekly income replacement benefits. This benefit provides you with income while you are unable to work as a result of your accident injuries. For the first two years following the accident, the test for this benefit is whether you suffer a substantial inability to perform the essential tasks of your employment. If you are unable to perform the majority of your regular duties at work, you may qualify for this benefit.

The amount of this benefit is 80% of your net weekly income (after deducting any other insurance benefits you receive related to your employment). The maximum weekly amount is $400 unless you have purchased optional insurance.

After 104 weeks, or two years, the test for disability changes. To meet the test, your injury must prevent you from engaging in any occupation or employment for which you are reasonably suited by education, training or experience. The amount of your benefit may also change. You will receive the greater of your previous weekly income amount or $185.00 per week.

The way in which your Income Replacement Benefit is calculated is different if your accident was after fall 2010.

Non-Earner Benefits

If you do not qualify as employed, you may be entitled to a non-earner benefit. For this benefit to apply, you must have a disability where you suffer a complete inability to carry on a normal life as a result of your car accident. This benefit has a 26 week waiting period. Benefits are paid at $185 per week. For students, this benefit will increase to $320 per week, after 104 weeks.

Caregiver Benefits

This benefit applies to those who are a primary caregiver of someone under 16 years of age or of someone who requires care due to physical or mental disability. For example, if you are a stay-at-home parent, you may be eligible for this benefit. The insurer will reimburse you for reasonable and necessary expenses incurred to have someone else provide care if you are unable to engage in your caregiving activities.

For accidents on or after September 1, 2010, this benefit may be only available if optional coverage was purchased.

Medical and Rehabilitation Benefits

Your insurance provides for all reasonable and necessary medical and rehabilitation expenses that you require as a result of your car accident. These are expenses that are not covered by any other medical plan such as Ontario Health Insurance Plan (OHIP) or any extended health care plans you may have through your employer or your spouse’s insurance plan. Such benefits can include costs for physiotherapy, massage therapy, chiropractic care, mobility devices such as wheelchairs, canes, casts, medications, etc. Your health care provider may be required to complete a treatment plan form. The costs of the treatment may be regulated by professional fee guidelines.

For accidents before September 1, 2010, Medical and Rehabilitation benefits are payable up to $100,000 for non-catastrophic claims and up to $1,000,000 for Catastrophic injury.

For accidents on or after September 1, 2010, the limit is $50,000 for non-catastrophic claims, unless you have purchased optional coverage. In addition, minor injuries may have a cap of $3,500 applicable.

Attendant Care Benefits

If you need someone to help you care for yourself as a result of your injuries, this benefit is intended to pay for the costs of an attendant or aide. Unless your injuries are Catastrophic, you will be eligible to claim up to $3,000 per month for such expenses. Coverage may be available for two years to a maximum of $72,000.00. If you have suffered what is defined as a Catastrophic impairment, you will be eligible for up to $6,000.00 per month to a maximum of $1,000,000. For accidents occurring on or after September 1, 2010, the standard attendant care coverage is up to $36,000 unless optional coverage has been purchased.

Housekeeping and Home Maintenance Benefits

If you are unable to do your normal housekeeping chores or grass cutting and snow removal as a result of your car accident injuries, you may be eligible for Housekeeping and Home Maintenance Benefits. This benefit allows for up to $100.00 per week, for up to 2 years (104 weeks), unless your injuries are classified as Catastrophic.

For accidents on or after September 1, 2010, this benefit may be only available if optional coverage was purchased.

Education Benefits

This benefit provides for up to $15,000.00 for lost tuition, books, equipment and boarding expenses for those who are students enrolled in an educational program and are unable to continue because of injury.

Visitor Expenses

Money spent for visiting an injured person during treatment or recovery may be covered under this benefit. To be eligible, the visitor has to be a relative.

Death and Funeral Benefits

When a car accident results in a fatality, surviving family members may be eligible for a death benefit. This amount is $25,000 for a surviving spouse, and $10,000.00 for each surviving dependent. There is also a benefit available of up to $6,000.00 for funeral expenses.