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You are entitled to insurance benefits if you are involved in a car accident.  Car insurance, mandatory in Ontario, provides access to these benefits. The benefits are available in almost every accident regardless of who is at fault. Normally coverage will be accessed through your own car insurer, or from another insurer of a vehicle involved in the accident. As a last resort, a fund set up by the Ontario Government will step in to provide coverage.  With benefits generally available, the real question becomes: what will these benefits provide?

Three Levels of Medical and Rehabilitation Benefits

The law in Ontario establishes three levels of statutory accident benefits. The differing levels of funding, without the purchase of optional benefits, are illustrated by the entitlement to medical rehabilitation benefits, which cover expenses incurred for medical services, such as a chiropractor, physiotherapist, or psychologist.

First, the lowest level of funding is for injuries falling within what is called the minor injury guideline, MIG. These benefits are available to every person injured in an accident involving a motor vehicle. Individuals sustaining a soft tissue injury, including a sprain, strain, whiplash, bruising, a laceration, or a partial joint dislocation are classified as being within MIG. Under this level, you are entitled to medical and rehabilitation benefits for up to 10 years, to a maximum of $3,500.00.

Second, the mid-level of funding is for injuries falling outside the MIG. This next level of benefit entitlement becomes available where an injured person has broken a bone, severed a tendon, suffered a brain injury, is suffering a psychological or mental aspect to the injury, such as depression or post-traumatic stress disorder or has developed chronic pain. Under this level, you are entitled to medical and rehabilitation benefits for up to 10 years, to a maximum of $50,000.00.

Third, the highest level of benefits represents a significant jump in entitlement, and is reserved for the most seriously injured individuals, including people suffering paraplegia or quadriplegia, a significant traumatic brain injury, the loss of the use of a limb, loss of vision in both eyes, or an injury resulting in a marked or severe impairment in work, daily life, or social functioning. Under this level, you are entitled to medical and rehabilitation benefits for life, to a maximum of $1,000,000.00.

Seeking Entitlement Beyond $3,500.00

An injured person has a duty to provide the insurer with information reasonably required for them to determine entitlement. This includes medical records, a statement setting out how the injuries happened, providing your address and proof of identity, and, if requested, attending at an examination under oath. However, even after this information is provided, disputes often arise between the injured person and the insurance company providing funding.

In many instances, injured people focus on their physical injuries, the aches, pains, sprains, bruises, and tend to ignore the psychological or mental injuries that can also be suffered as a result of a car accident. Frequently, individuals can suffer from anxiety, post-traumatic stress, or depression, following a traumatic event such as a car crash. Head injuries, including concussions, tend also to be overlooked by an injured person or their treating doctor. However, the psychological fall-out is no less important and no less deserving of medical care than other injuries. When these injuries are properly identified and reported to your doctor, they will ensure you are not limited to the lowest level of benefits and they can be properly treated.

Furthermore, injured people may overlook the significance of a prior medical condition, and how it can impact on the recovery from a car accident. Should your doctor be of the opinion that a documented history of previous injuries, anxiety or depression, or a past history of chronic pain (for example) or other chronic conditions, is preventing your full recovery from the injuries suffered in the car accident, then you are entitled to enhanced benefits. Similarly, injuries persisting into a chronic condition fall outside of the definition of the MIG, and should entitle you to enhanced benefits.

We Can Help

In many instances, injured individuals take all the appropriate steps in recovering from their injuries. They seek treatment, report their symptoms, attend their appointments, and have the support of their family doctor. Yet, even when medical records are provided and a statement is given, an insurer may limit entitlement to $3,500.00 and deny further funding for treatment deemed necessary by the inured person’s treatment team. In these cases, an insurer may have sent the injured person for a medical examination funded by the insurance company, producing a report that is at odds with your family doctor or treatment team. At this point, with conflicting medical opinion, mediation and arbitration, or a court case, may be the only way of obtaining the benefits required for a full recovery.

In addition to medical and rehabilitation care a person injured in a car accident may also be entitled to attendant care and housekeeping assistance. It is important to know your rights in this regards. If the insurance company does not clearly explain these to you, legal advice may be needed.

Knowing what questions to ask of your doctor, ensuring all of your symptoms are properly reported, and knowing the potential benefits and how to claim them through mediation, arbitration, or a court case, is crucial for advancing a complete and comprehensive claim for compensation following personal injury. If you have any questions regarding accident benefits, or your entitlements, please contact Maciek Piekosz via email at [email protected] or call 519-660-7718 for a free consultation.

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