When you’re injured in a motor vehicle accident, getting better should be your top priority. Sometimes, however, the costs of treatment can feel prohibitive or add unneeded stress to your recovery. In Ontario, you may be entitled to statutory medical, rehabilitation, and attendant care benefits that can help ease the burden of paying for your treatment following a car accident.

As we noted in last week’s post addressing statutory accident benefits for income loss specifically, entitlement to benefits for medical costs, rehabilitation, and attendant services can be complicated. Below, we will outline some key things you should know if you are considering applying for statutory accident benefits to assist you with medical care to help you recover from and manage your injuries.

Statutory Accident Benefits for Medical Costs Following a Motor Vehicle Accident in Ontario

Under Ontario’s Insurance Act, people who sustain injuries as a result of a motor vehicle accident and require medical or rehabilitative treatment are entitled to benefits pending the resolution of their dispute. This means that you are eligible to receive the benefits to which you are entitled without having to wait for your case to settle or go to court.

Am I Eligible for Statutory Accident Benefits?

To be eligible for statutory accident benefits for medical costs, the person claiming benefits must have sustained an “impairment” in a motor vehicle accident.

Which Medical Costs Do Statutory Accident Benefits Cover?

Medical benefits will cover all “reasonable and necessary” expenses incurred by or on behalf of the injured person, including common treatments such as chiropractic, psychological, occupational therapy, and physiotherapy services and transportation for the insured person to and from treatment sessions. The Statutory Accident Benefits Schedule provides a comprehensive list of the types of treatments covered. If you are unsure of the coverage to which you may be entitled, your personal injury lawyer can help you determine your eligibility.

How Long Can I Expect to Receive Statutory Accident Benefits?

Unlike income replacement benefits, which we discussed last week, the amount of coverage an injured person receives for medical costs is primarily based on the type of injury or injuries sustained.

A “minor injury” is defined in the Minor Injury Guideline as one or more of a sprain, strain, whiplash-associated disorder, contusion, abrasion, laceration, partial dislocation, and any clinically associated aftereffects.  

A “catastrophic injury” includes paraplegia or tetraplegia; severe impairment of ambulatory mobility or use of an arm, or amputation; loss of vision of both eyes; or traumatic brain injury meeting certain requirements.

If the injured party sustained a minor injury, the total amount covered by statutory accident benefits for medical and rehabilitative care cannot exceed $3,500 plus tax. However, an injured person who sustained a minor injury may be entitled to further coverage if their health care practitioner determines and provides compelling evidence that the injured person has a pre-existing medical condition that was documented by a health practitioner before the accident and that will prevent the insured person from achieving maximal recovery from the minor injury.

If the injured party sustained a catastrophic injury, the total amount covered by statutory accident benefits for medical and rehabilitative care cannot exceed $1,000,000 plus tax.

If the injured party sustained an injury not considered “minor” or “catastrophic”, the total amount covered by statutory accident benefits for medical and rehabilitative care cannot exceed $65,000 plus tax.

Am I Eligible for Statutory Accident Benefits for a Caregiver?

In certain circumstances, and if your impairment is not a “minor injury” you may also be entitled to attendant care benefits. Attendant care benefits cover all reasonable and necessary expenses incurred by or on behalf of an injured person because of the accident for services provided by an aide or attendant or by a long-term care facility.

Skilled Motor Vehicle Accident Lawyers Serving Eastern Ontario and North Bay

A motor vehicle accident is a stressful event that is often made even more stressful due to financial worry and uncertainty. At Tierney Stauffer LLP, our personal injury lawyers will help you make decisions about what to do following your car accident and ensure you receive the benefits you are entitled to promptly.

At Tierney Stauffer LLP, we take a client-centred approach to personal injury claims. We have many years of experience in analyzing the factors of each case in order to determine the appropriate course of action for your case to ensure you receive the best possible result. Call us at 1-888-799-8057 or contact us online to set up a free consultation and discuss your matter with a member of our team.


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