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Important changes to Ontario’s Statutory Accident Benefits Schedule (“SABS”) – what you need to know

Posted Nov 11th, 2016

Important changes to Ontario’s Statutory Accident Benefits Schedule (“SABS”) – what you need to know

All owners of vehicles in Ontario must purchase a standard auto insurance policy.  If you or your loved ones are seriously injured in a car accident, then you are entitled to receive “No Fault” Statutory Accident Benefits. 


However, on June 1, 2016 the benefits and coverage in the standard auto insurance policy changed.  These changes will impact car accident victims in a significant way.  It is critical that you speak to your insurance representative about these important changes.

The changes apply to policies issued or renewed on or after June 1, 2016.  Existing policies remain subject to the current limits until the policy is terminated or renewed.

The following is a summary of the key changes every insured should be aware of:

New Standard Benefit: A new standard benefit that combines medical, rehabilitation and attendant care benefits is set at $65,000.  Prior to June 1, 2016, the standard auto insurance policy provided for a standard medical-rehabilitation benefit of $50,000 and a separate standard attendant care benefit of $36,000.

Change in Duration: The duration of the new standard medical, rehabilitation and attendant care benefit is 5 years for non-Catastrophic Impairment cases.  Prior to June 1, 2016, the standard auto insurance policy provided for a duration limit for medical-rehabilitation benefits of 10 years.  Take note that the new duration period does not apply to children under 18 at the time of the accident.  If the car accident victim is under 18, the benefits are payable until age 28.

New Catastrophic Impairment Limit: For Catastrophic Impairment claims, a new combined medical, rehabilitation and attendant care benefit of $1,000,000 is available for life.  Prior to June 1, 2016, the standard auto insurance policy provided for two separate limits of $1,000,000 for medical-rehabilitation benefits and attendant care benefits for Catastrophic Impairment claims.  The new 5 year time limitation does not apply if the insured person sustains a Catastrophic Impairment, or has purchased additional optional benefits of $1,000,000 in medical, rehabilitation and attendant care benefits.  In addition, the definition of Catastrophic Impairment has been significantly narrowed making it more difficult to satisfy entitlement to this benefit.

Expenses of Under $250: For any medical-rehabilitation expenses of under $250, the auto insurer now requires the expense to be essential for treatment in order to approve the expenses, versus previously being able to incur the expense.

 Attendant Care Reimbursement: With respect to attendant care, now the insured can only be reimbursed up to the amount actually incurred in having a professional provide attendant care.  For example if the Form 1 is for $2,500 per month and a PSW company charged $500 for the month, the insured will get $500, not $2,500.
 
Non-Earner Benefit: The duration of the Non-Earner Benefit (“NEB”) is changed to 2 years (versus for life) following the accident with an initial waiting period of 4 weeks (versus 26 weeks).  It is not payable to those 18 or younger, until they are 18.  The amount of the benefit is limited to $185 per week and will no longer increase to $320 per week for students.

In addition, as of April 1, 2016, the way accident benefit disputes will be handled has changed.  The License Appeals Tribunal (LAT) will handle arbitration applications instead of FSCO.  There will be no more mandatory mediations in advance of arbitration.  Instead, an applicant will be able to apply for arbitration immediately upon his or her benefit being denied or terminated.  If the matter does not settle at the case conference (similar to FSCO’s pre-arbitration hearing), then the hearing will proceed by written format or expedited, electronic format.  In-person hearings will be reserved for the most serious cases such as catastrophic impairment claims.

It is essential that you speak to your insurance representative and ask questions before you renew your policy.  Finding an insurance policy that will offer you and your family the most protection should be a priority.  Make sure you know what options are available to increase or purchase other benefits to ensure you and your family are protected. 


 

Freda Vanopoulos is an associate at Virk Personal Injury Law with extensive experience in personal injury litigation including motor vehicle accident injuries, statutory accident benefits claims, slip and fall accidents, defective product injuries and long-term disability insurance claims.  She can be reached at: 

Virk Personal Injury Law
Professional Corporation
293 Wellington St. S, Suite 105
Hamilton, ON  L8L 8E7
Tel: 905-521-8888
Fax: 905-521-8858
Email: Freda@virklawyers.com
Twitter: @FredaVanopoulos
LinkedIn: https://ca.linkedin.com/in/freda-vanopoulos-ab752b31



 

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