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It is a requirement to have automobile insurance in Ontario. The implications of not having it are many and severe. Drivers can receive a fine in the thousands of dollars, have their driver’s license suspended and vehicle impounded if they do not carry a valid insurance policy.

Understanding car insurance policies, however, can be quite overwhelming. For starters, a policy has coverages that are mandatory (e.g. third-party liability, statutory accident benefits, property damages, and uninsured automobile coverage) and coverages that are optional.

If you are in the eve of renewing or contracting for the first time an automobile insurance policy in Ontario, you may want to better understand what ‘accident benefits coverage’ means.

Accident benefits coverage is the portion of the policy that allows an insured injured in a motor vehicle collision to claim benefits with their own insurance company despite of who was at fault for the collision.

Generally, the mandatory accident benefits coverage includes benefits for medical, rehabilitation and attendant care, caregiver, non-earner and income replacement benefits. If contracted, the optional benefits can increase the coverage of the mandatory accident benefits. The table below presents an overview of some important differences between the benefits under a mandatory and an optional accident benefits coverage:

Mandatory accident benefits coverage

Optional accident benefits coverage

Medical, rehabilitation and attendant care benefits

Allow claims to access to some treatments not covered by OHIP (e.g. physiotherapy, chiropractic treatment, etc.), claims for mobility devices (e.g. wheelchairs) and claims for assistant care (e.g. assistance from a personal support worker for activities of daily living).

Typically, the quantum of benefits is capped at $65,000 for serious non-catastrophic injuries, and $1,000,000 for catastrophic injuries.

Generally, the optional benefits increase the quantum of benefits claimable to $130,000 for serious non-catastrophic injuries and up to $2,000,000 for catastrophic injuries. Even further benefits are available under this category.

Caregiver benefits

This benefit may be claimed by those who, at the time of the accident, provided full-time care for a dependant (e.g. children and aging parents) residing with them, and, due to the collision, can no longer provide such care requiring that they hire help.

Generally, the injured person must have suffered catastrophic injuries in a motor vehicle collision to claim this benefit.

The injured person is not required to have suffered catastrophic injuries to claim this benefit.

Income replacement benefits

Generally claimable for an amount of up to $400/week.

Depending on the policy, the amount claimable as income replacement benefits can be up to $1,000/week.

Housekeeping and home maintenance benefits

This benefit covers the costs of hiring someone to perform housekeeping and/or home maintenance tasks that the injured person used to perform prior to the collision.

Normally claimable only by those who, as a result of the collision, have been catastrophically injured.

This benefit is not exclusive to individuals who were catastrophically injured in a collision.

Death and funeral benefits

This benefit is claimable in the event the insured dies as a result of the motor vehicle collision.

The benefit provides up to $25,000 for the eligible spouse, up to $10,000 to each eligible dependant, and a maximum of $6,000 for funeral expenses.

The benefit is usually capped at $50,000 for the eligible spouse, $20,000 to each dependant, and $8,000 for funeral expenses.

Indexation

This benefit provides annual adjustment for inflation to other benefits such as income replacement, non-earner benefit, medical, rehabilitation and attendant care benefits.

This benefit is not part of the mandatory accident benefits policy.

This benefit can be contracted as an optional benefit.

Dependant care benefits

This benefit covers those who were employed at the time of the collision and as a result of the injuries sustained in the accident had to pay for additional childcare expenses.

This benefit is not part of the mandatory accident benefits policy.

Typically, a dependant care benefit claim may cover up to $75/week for the first dependant and $25/week for each additional dependant, to a maximum amount of $150/week.

The variety of options available beyond the mandatory ‘accident benefits coverage’ is significant. The most appropriate policy for each individual and whether it should include optional coverages is a personal choice. It is worth checking with an insurance broker how each or all of the optional benefits may impact the insurance premium and discuss whether any optional benefits would be recommended for you and your family. Insurance brokers are the licensed professionals to assist with this decision in Ontario.

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