Many people who are injured in a car accident for the first time do not know where to go to ensure that they have the medical coverage they need to recover from their injuries.
If a person is fortunate enough to have benefits through his or her workplace or through the workplace of a spouse or parent, then the first recourse is to apply for benefits through this system.
Once a person has exhausted his or her “collateral benefits”, he or she is entitled to certain benefits from his or her own automobile insurance company. These benefits from a person’s own automobile insurance company are commonly known as “no-fault benefits” or “accident benefits”. Accident benefits are detailed in the Statutory Accident Benefits Schedule (SABS), which is a regulation of the Insurance Act.
The accident benefits that a person is entitled to receive will typically be based on the type of injury that he or she has suffered in the car accident. Accident benefits can be considered under three categories. The most severely injured people will be deemed “catastrophically impaired”. People who have suffered soft tissue, pains and strains, or partial tears will be placed in the minor injury guideline (“MIG”). Individuals whose injuries fit into neither the catastrophic category nor the minor injury guideline category can be considered “non-catastrophic”.
If a person has been injured in a car accident, he or she may issue a claim against the at-fault driver. This claim is commonly referred to as a “tort” claim.
There are, however, certain restrictions a person will face when pursuing a tort claim. For one, a person must prove that his or her injuries meet a certain level of severity, commonly referred to as “the threshold”, to recover anything for certain types of losses, including pain and suffering. Additionally, if the damages that an individual is awarded for pain and suffering are $100,000 or less, there is a statutory deductible of $30,000. This means that if an individual is awarded $30,000 for pain and suffering, he or she will in fact receive nothing. (Similarly, if an individual is awarded $95,000 for pain and suffering, they will actually receive $65,000.) Finally, there is a limitation period in Ontario that is normally two years from the date of the accident. This means that an individual must issue a statement of claim with the court before the second anniversary of the accident. If a person waits more than two years, that person may be barred from pursuing the claim even if it is otherwise a strong claim.
This posting is meant to provide only general information not legal advice. Individuals should hire a lawyer to obtain legal advice with respect to the specifics of their particular case.