Income replacement Benefits (Same for Catastrophic, Non-Catastrophic, Minor Injury Claims)
Applicants for income replacement benefits must have severe injuries that prevent them from working or working in the same way they did before their injury. In order to become eligible for these benefits the injured person must meet one or more of the following qualifications:
- Employed at the time of the accident (including self-employment);
- Worked for 26 or more weeks out of the 52 weeks preceding the accident;
- Receiving Employment insurance at the time of the crash; or
- Not employed but at least 16 years old and excused from attending school at the time of the crash.
As established in S.6(1) of the SABS, an “income-replacement benefit is payable for the period in which the insured person suffers a substantial inability to perform the essential tasks of his or her employment or self-employment”. IRB payments are made at least every two weeks and cover up to 70% of the injured person’s gross weekly income. These payments may not exceed $400 per week. The maximum level of IRB’s will be paid out for up to 104 weeks after the time of the accident.
The threshold for receiving IRBs becomes much more difficult to pass after the 104-week mark. Section 6 of the Statutory Accident Benefits Schedule outlines the test for post-104 week IRBs as follows: “as a result of the accident, the insured person is suffering a complete inability to engage in any employment for which he or she is reasonably suited by education, training, or experience.”
Complete inability represents a higher degree of disability than substantial inability, raising the standard beyond a relatively sizable disability.
In order to continue to qualify for IRBs, you may be required to attend any insurer examinations, where doctors will assess your ability to return to work; participate in the recommended rehabilitation program, and to make attempts to return to work. Failing to participate may result in the insurer stopping IRB payments until you do.
Non-earner Benefits (Same for Catastrophic, Non-Catastrophic, Minor Injury Claims)
Section 12(1) of the SABS establishes that applicants are eligible for non-earner benefits if “the insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident”:
I. was enrolled on a full-time basis in elementary, secondary or post-secondary education at the time of the accident, or
II. completed his or her education less than one year before the accident and was neither employed nor a self-employed person after completing his or her education and before the accident, in a capacity that reflected his or her education and training.
There is a 4-week waiting period before you can qualify for this benefit. Once qualified, an injured person will receive $185 each week for a maximum of 104 weeks.
Medical, Rehabilitation, and Attendant Care Benefits
S. 20. (1)(a) No medical, rehabilitation and attendant care benefit is payable for expenses incurred more than 260 weeks after the accident.
S. 18 (3) The sum of theses medical, rehabilitation and attendant care benefits shall not exceed, for any one accident,
(a) $65,000 plus the amount of any applicable harmonized sales tax payable under Part IX of the Excise Tax Act (Canada) for accidents that occur on or after June 3, 2019; or Catastrophic Impairment
S. 18/19. If the insured person suffers an impairment which rises to the level of catastrophic impairment, then the available medical and rehabilitation benefits increase to $1,000,000 payable over the insured person’s lifetime and the available attendant care benefits increase to a maximum of $6,000 per month payable over the person’s lifetime or until $1,000,000 has been exhausted.
S. 45. (4) If an application is made under this benefit not more than 260 weeks after the accident and, immediately before the application was made, the insured person was receiving attendant care benefits, (a) the insurer shall continue to pay attendant care benefits to the insured person during the period before the insurer makes a determination under this section.
S. 18 (3) The sum of the medical, rehabilitation and attendant care benefits paid in respect of an insured person who is not subject to the financial limit in the Minor Injury Guideline shall not exceed, for any one accident,
(b) if the insured person sustained a catastrophic impairment as a result of the accident, $1,000,000 plus the amount of any applicable harmonized sales tax payable under Part IX of the Excise Tax Act (Canada) for accidents that occur on or after June 3, 2019. O. Reg. 251/15, s. 8 (1); O. Reg. 123/19, s. 2 (3, 4).
Minor Injury Guideline
Minor Injury Benefits do not include attendant care benefits.
Section 18 (1) of the SABS establishes that a person who sustains an impairment that is predominantly a minor injury shall not exceed $3,500 a week for 260 weeks in medical and rehabilitation benefits. O. Reg. 34/10, s. 18 (1); O. Reg. 123/19, s. 2 (1).
However, the limit in subsection (1) does not apply to an insured person if his or her health practitioner determines and provides compelling evidence that the insured 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 insured person is subject to the limit or is limited to the goods and services authorized under the Minor Injury Guideline. O. Reg. 34/10, s. 18 (2); O. Reg. 347/13, s. 1; O. Reg. 123/19, s. 2 (2).
Caregiver Benefits (Only for Catastrophic Impairments)
The insurer shall pay a caregiver benefit to or for an insured person who sustains catastrophic impairment as a result of an accident if, as a result of and within 104 weeks after the accident, the insured person suffers a substantial inability to engage in the caregiving abilities in which he or she was engaged at the time of the accident.
No caregiver benefit is payable for any period longer than 104 weeks of disability unless, as a result of the accident, the insured person is suffering complete inability to carry on a normal life