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FAQs

Car Accidents

My insurance company is handling everything. Why do I need a lawyer?

Your insurance company has its own lawyers to provide it with good legal advice about its rights and responsibilities. You need the same legal advice for yourself. In our experience, insurers can often be helpful at the beginning of a case, but are not looking out for your best interests. In the long run, they are seeking to limit payments to you. As well, insurance companies are not permitted to provide you with legal advice about your right to sue. Therefore, if you have been in a car crash and wish to consider a lawsuit, you need independent advice about your rights. Given that strict time limits apply in some cases, you should not delay in getting legal advice. The scene of the crash may also be important to your case, and early attendance by a photographer, engineer or investigator may be needed to preserve your right to claim. At Legate & Associates, we can help you evaluate your options if you have been injured in a car crash.

 

If you have any additional questions, please feel free to contact us.

I was in a single car crash. Do I need a lawyer? Who do I sue?

Even in a single car crash you can be a victim of negligence as road authorities can be liable for hazardous road conditions. For example, road authorities, such as cities, counties or the Ministry of Transportation, may be liable for ice and snow covered roads, defects on the road surface before or during road construction and improper road design or sightline obstructions. Other causes of single car crashes can be related to car defects or negligent repairs. In these cases, you would be able to sue your car manufacturer or mechanic if the defect caused your crash.

 

If you have any additional questions, please feel free to contact us.

Can I sue the other at-fault driver?

In general, you can sue the driver responsible for an accident in two situations: when you are injured in an automobile accident in Ontario or when a family member has been injured or killed in an accident. However, you may still sue the other driver even if you or the family member is partly responsible for the accident.

 

If you have any additional questions, please feel free to contact us.

What are Statutory Accident Benefits?

Statutory Accident Benefits are "no fault" benefits available to you from your own insurer when you are involved in a car crash. This means that no matter who was at fault in the collision, your own insurer must pay for goods, services and other benefits provided for by the insurance policy that you need because of the collision. These benefits may include, but are not limited to, income replacement benefits, caregiver benefits, non-earner benefits, medical and rehabilitation benefits, attendant care, housekeeping and home maintenance, and other expenses incurred for damaged clothing or visitor’s expenses when you are in hospital. The type and amount of benefits that may be available to you will depend on whether your injury fits certain legally defined injury categories and whether you purchased optional insurance coverage before the accident.

 

If you have any additional questions, please feel free to contact us.

How do I get Statutory Accident Benefits from the insurer?

You have to apply to your own insurance company in order to receive Statutory Accident Benefits from your insurer. You will be asked to complete an application form and provide information about your injuries, the collision and your income. After the application is made, there are a number of forms that must be completed by your doctor, employer and perhaps others that will support your right to benefits.

 

If you have any additional questions, please feel free to contact us.

I was a pedestrian or bicyclist injured by a car. Can I receive accident benefits?

Cyclists and pedestrians struck and injured by a car can receive accident benefits. If you do not own a vehicle or you are not an insured person under someone else’s automobile insurance policy, you can claim accident benefits from the automobile insurer of the car that injured you.

 

If you have any additional questions, please feel free to contact us.

What medical expenses will the insurer pay for?

In general, any medical expense arising from the car accident not covered by your health plan, extended health benefits plan or OHIP are payable by your automobile insurer. This may include, but is not limited to:

 
  • medical

  • surgical

  • dental

  • optometric

  • hospital

  • nursing

  • ambulance

  • audiometric

  • speech-language pathology services

  • chiropractic

  • psychological

  • occupational therapy

  • physiotherapy

  • medications

  • prescription eyewear

  • dentures and other dental devices

  • hearing aids

  • wheelchairs

  • prostheses, as well as orthotics

  • and other assistive devices

 

However, the benefits that may be available to you will depend on whether your injury fits certain legally defined injury categories and whether you purchased optional insurance coverage before the accident. Additional benefits are available to you if you are very seriously injured; this is referred to as "catastrophic impairment". If you are considered catastrophically impaired, you are also entitled to a case manager to help you co-ordinate all of your medical and rehabilitation needs.

 

If you have any additional questions, please feel free to contact us.

What rehabilitation expenses will the insurer pay for?

Your automobile insurer must pay all reasonable costs for you to reduce or eliminate the effects of any disability to help you return to your family, society and appropriate work. However, the benefits that may be available to you will also depend on whether your injury fits certain legally defined injury categories and whether you purchased optional insurance coverage before the accident. Rehabilitation benefits can include life skills training, family counseling, social rehabilitation counseling, financial counseling, employment counseling, vocational assessments, vocational or academic training, workplace modifications and/or devices, home modifications and/or home devices, and vehicle modifications.

 

If you have any additional questions, please feel free to contact us.

How do I collect medical and rehabilitation benefits?

Your medical and rehabilitation should be under the direction of your physician or other health practitioner, and he or she should recommend appropriate treatment. Some injuries that fit certain legally defined injury categories do not require the insurer’s prior approval in order to receive benefits to fund assessments or treatment. In other cases, the treatment provider must complete a treatment and assessment form, which requires your signature, to obtain permission from your insurer to conduct an assessment or provide treatment. If your insurer agrees that you require the assessment or treatment, they will notify your treatment provider and an assessment can then be done and a treatment plan can be developed, which is then sent to your insurer for funding consideration.

 

In order to help ensure that your assessment and treatment is not delayed significantly, your insurer has 10 business days to approve a request to conduct an assessment or to approve a treatment plan. If your insurer misses this deadline, the request is considered approved until the insurer ultimately responds. If your insurer does not approve a request to assess or a treatment plan, your insurer may decide to have you assessed by a health practitioner of their own to assist them in their decision. If your insurer maintains its decision, you can either withdraw the request for the benefits, or seek to have your disagreement discussed in the presence of a mediator. Possible further legal steps are arbitration or a lawsuit against your own insurer.

 

If you have any additional questions, please feel free to contact us.

What should I expect to receive in Income Replacement Benefits?

If you are employed and have no benefits through a private insurance policy, your own insurance company is obligated to pay you income replacement benefits for any time you are unable to work because of impairments from injuries sustained in a car crash. As a general rule, if your accident occurred on or after September 1, 2010, the income replacement benefit is 70% of your gross income earned before the accident, less statutory deductions, to a maximum of $400 per week. If you have purchased additional benefits, the maximum may be increased to $600, $800 or $1,000 per week. Your gross income can be calculated on average weekly income earned in the 52 weeks or 4 weeks before the crash, whichever is greater. Benefits are not available for the first seven days following the injury.

 

If you have any additional questions, please feel free to contact us.

How long will I receive Income Replacement Benefits?

You are entitled to this benefit until you are able to work in either your own job or another job for which you are reasonably suited. There is no time limit, but the benefit amounts are adjusted after age 65.

 

If you have any additional questions, please feel free to contact us.

Are there any maximums on Statutory Accident Benefits?

 

Unfortunately, yes. If your accident occurred on or after September 1, 2010 and your injuries are considered non-catastrophic you are entitled to maximums of $50,000 in medical and rehabilitation benefits over 10 years, $36,000 for attendant care benefits over two years at no more than $3,000 per month unless optional benefits were purchased before the accident. Housekeeping and home maintenance benefits are only available to those involved in collisions on or after September 1, 2010 with non-catastrophic injuries, if optional benefits have been purchased, and then only to a maximum of $100 per week for two years. If your injuries are non-catastrophic, you are only entitled to claim transportation expenses after the first 50 kilometers per trip, even for medical and rehabilitation appointments.

 

If your injuries are considered catastrophic you are entitled to maximums of $1,000,000 over your lifetime for medical and rehabilitation benefits, $1,000,000 for attendant care benefits over your lifetime at no more than $6,000 per month, and housekeeping and home maintenance benefits to a maximum of $100 per week for life. There is no minimum mileage limit for transportation expenses. You may be entitled to increased benefit maximums if your injuries are catastrophic and you purchased optional insurance before the accident.

 

If your accident occurred on or after September 1, 2010 and your injuries are considered to be minor, you may be entitled to a maximum of only $3,500 for medical and rehabilitation benefits. Housekeeping and home maintenance benefits are available if you purchased optional benefits to a maximum of $100 per week for two years, but no attendant care benefits are available.

 

If you have any additional questions, please feel free to contact us.

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