Income Replacement Benefits

Your insurer will cover a loss of income with a benefit called an income replacement benefit. The insurer will pay an insured person who sustains an impairment as a result of an accident an income replacement benefit if the insured person was employed at the time of the accident and, as a result of and within 104 weeks after the accident, suffers a substantial inability to perform the essential tasks of that employment.

 

If the insured person was not employed at the time of the accident, he or she may still be entitled to the income benefit if employed for at least 26 weeks during the 52 weeks before the accident or was receiving benefits under the Employment Insurance Act (Canada) at the time of the accident.

 

There are some limits on the ability to claim the income benefit. For example, an insured person is not allowed to claim for the first week of the disability. As well, an insured person cannot claim this benefit for any period longer than 104 weeks of disability, unless, 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.

 

With respect to the amount of your income benefit, it is either $400 for each of the first 104 weeks of disability or 70 percent of the insured person’s net weekly income from employment, whichever is less. After 104 weeks of disability, the amount is the greater of the 70 percent of net income (up to a maximum of $400) and $185.

Any income loss between $400 and 80% of net income may be recovered against the at-fault driver.

 

 

Non-Earner Benefits

An insured person may also claim a non-earner benefit. This benefit is usually available to individuals who were not working at the time of the accident and did not meet the criteria to claim an income replacement benefit.

The insurer shall pay an insured person who sustains an impairment as a result of an accident a non-earner benefit 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 and does not qualify for an income replacement benefit, the insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident, received a caregiver benefit as a result of the accident and there is no longer a person in need of care, or the insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident and (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 not employed, after completing his or her education and before the accident, in an employment that reflected his or her education and training.

The amount of the non-earner benefit shall be $185 for each week that the insured person is eligible to receive the benefit. However, you are not entitled to claim this benefit for the first 4 weeks following the accident.

 

 

Caregiver Benefits

Another benefit available is a caregiver benefit. The insurer shall pay an insured person who sustains an impairment as a result of an accident a caregiver benefit if the insured person meets all of the following qualifications:

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1. At the time of the accident,

   i. the insured person was residing with a person in need of care,

  ii. the insured person was the primary caregiver for the person in need of care and did not receive any remuneration for engaging in caregiving activities.

 

2. As a result of and within 104 weeks after the accident, the insured person suffers a substantial inability to engage in the caregiving activities in which he or she engaged at the time of the accident.

The caregiver benefit shall pay for reasonable and necessary expenses incurred as a result of the accident in caring for a person in need of care. A person in need of care” means another person who is less than 16 years of age or who requires care because of physical or mental incapacity.

The amount of the caregiver benefit shall not exceed $250 for the first person in need of care. For each additional person in need of care, the insurer will pay up to a maximum of $50. For example, if there are two children under the age of 16, you may be entitled up to a maximum of $300 a week for this benefit.

The insurer is not required to pay a caregiver benefit for any period longer than 104 weeks of disability, unless, as a result of the accident, the insured person is suffering a complete inability to carry on a normal life.

 

Medical, Rehabilitation and Attendance Care Benefits

 

a) Medical Benefit

The insurer shall pay an insured person who sustains an impairment as a result of an accident a medical benefit.

The medical benefit shall pay for all reasonable and necessary expenses incurred by or on behalf of the insured person as a result of the accident for medical, surgical, dental, optometric, hospital, nursing, ambulance, audiometric and speech-language pathology services; chiropractic, psychological, occupational therapy and physiotherapy services; medication; prescription eyewear; dentures and other dental devices; hearing aids, wheelchairs or other mobility devices, prostheses, orthotics, and other assistive devices; transportation for the insured person to and from treatment sessions, including transportation for an aide or attendant; and other goods and services of a medical nature that the insured person requires.

The insurer is not liable to pay a medical benefit for goods or services that are experimental in nature.

Note that there are limits as to the amount of medical benefits available to you.

 

 

b) Rehabilitation Benefit

The insurer shall pay an insured person who sustains an impairment as a result of an accident a rehabilitation benefit. The rehabilitation benefit shall pay for reasonable and necessary measures undertaken by an insured person to reduce or eliminate the effects of any disability resulting from the impairment or to facilitate the insured person’s reintegration into his or her family, the rest of society, and the labor market. The rehabilitation benefit shall pay for all reasonable and necessary expenses incurred by or on behalf of the insured person as a result of the accident for a purpose life skills training; family counseling; social rehabilitation counseling; financial counseling; employment counseling; vocational assessments; vocational or academic training; workplace modifications and workplace devices, including communications aids, to accommodate the needs of the insured person; home modifications and home devices, including communications aids, to accommodate the needs of the insured person, or the purchase of a new home if it is more reasonable to purchase a new home to accommodate the needs of the insured person than to renovate the insured person’s existing home; vehicle modifications to accommodate the needs of the insured person, or the purchase of a new vehicle if it is more

reasonable to purchase a new vehicle to accommodate the needs of the insured person than to modify an existing vehicle; transportation for the insured person to and from counseling and training sessions, including transportation for an aide or attendant

Note that there are limits as to the amount of rehabilitation benefits available to you.

 

c) Attendant Care Benefit

The insurer shall pay an insured person who sustains an impairment as a result of an accident an attendant care benefit, unless the accident occurred after April 14, 2004, where no attendant care benefit is payable to an insured person whose impairment is a Grade I or Grade II whiplash-associated disorder that comes within a Pre-approved Framework Guideline.

The attendant care benefit shall pay for all reasonable and necessary expenses incurred by or on behalf of the insured person as a result of the accident for services provided by an aide or attendant; or services provided by a long-term care facility, including a nursing home, home for the aged or chronic care hospital.

Note that there are limits as to the amount of attendant care benefits available to you.

No attendant care benefit is payable for expenses incurred more than 104 weeks after the accident, except in respect of an insured person who sustains a catastrophic impairment as a result of the accident.

 

 

d) Payment of Other Expenses

 

Lost Educational Expenses

The insurer shall pay for lost educational expenses incurred by or on behalf of an insured person who sustains an impairment as a result of an accident if,

   (a) at the time of the accident, the insured person was enrolled in a program of elementary, secondary, post-secondary or continuing education; and

   (b) as a result of the accident, the insured person is unable to continue the program.

The amount payable under this section shall not exceed $15,000.

   b) Expenses of Visitors

If an insured person sustains an impairment as a result of an accident, the insurer shall pay for reasonable and necessary expenses incurred by the following persons as a result of the accident in visiting the insured person during his or her treatment or recovery:

 

   1. The spouse, children, grandchildren, parents, grandparents, brothers, and sisters of the insured person.

   2. An individual who was living with the insured person at the time of the accident.

   3. An individual who has demonstrated a settled intention to treat the insured person as a child of the individual ’s family.

   4. An individual whom the insured person has demonstrated a settled intention to treat as a child of the insured person’s family.

No payment is required under this section for expenses incurred more than 104 weeks after the accident but does not apply if the insured person sustained a catastrophic impairment as a result of the accident.

 

Housekeeping and Home Maintenance

The insurer shall pay for reasonable and necessary additional expenses incurred by or on behalf of an insured person as a result of an accident for housekeeping and home maintenance services if, as a result of the accident, the insured person sustains an impairment that results in a substantial inability to

perform the housekeeping and home maintenance services that he or she normally performed before the accident.

The amount payable under this section shall not exceed $100 per week. No payment is required under this section for expenses incurred more than 104 weeks after the onset of the disability but does not apply if the insured person sustained a catastrophic impairment as a result of the accident.

Damage to Clothing, Glasses, Hearing Aids, etc.

The insurer shall pay for all reasonable expenses incurred by or on behalf of an insured person in repairing or replacing

 

   (a) Clothing is worn by the insured person at the time of an accident that was lost or damaged as a result of the accident; or

   (b) Prescription eyewear, dentures, hearing aids, prostheses and other medical or dental devices that were lost or damaged as a result of an accident.

 

Death and Funeral Benefits

 

a) Death Benefit

The insurer shall pay a death benefit in respect of an insured person if he or she dies as a result of an accident. The death benefit shall pay $25,000 to the insured person’s spouse and $10,000 for each of the insured’s dependents, and to each person to whom the insured person had an obligation at the time of the accident to provide support under a domestic contract or court order unless the insured had optional benefits.

 

b) Funeral Benefit

The insurer shall pay a funeral benefit in respect of an insured person who dies as a result of an accident. The funeral benefit shall pay for funeral expenses incurred in an amount not exceeding $6,000 unless the insured had an optional funeral benefit.