content top

Accident Benefits

Q.   How can your office assist me if I was in an motor vehicle accident?

We can assist you in accessing and appealing Statutory Accident Benefits (SABS).

Q.   When can I make a claim under SABS?

You can be a driver of a vehicle, a passenger, a pedestrian, a cyclist, or even using public transit at the time.  You do not have to own a vehicle and carry your own auto insurance. A claim can be made as long as you were hurt or injured in any kind of accident involving a motor vehicle.

Q.    What kind of benefits can I claim under SABS?

In general, one can claim Income Replacement Benefits up to a limit of $400 a week, medical-rehabilitation and if you were seriously injured, Caregiving and Housekeeping.  For accidents that took place prior to September 1st, 2010, you can make a claim for Caregiving and Housekeeping even if you were less seriously injured.  There are other claims you can make too, such as lost educational expenses, out-of-pocket expenses, medical report fees, etc.  Each case is different, so it is best to seek legal advice even when you make an application for these benefits.

Q.   Can I sue the other driver if I was in an accident?

Yes, you can, if your injuries are serious enough to meet “threshold”.  If you feel your injuries are serious enough, a case must be filed no later than two (2) years from the date of the accident.   Because of the structure of the tort system, claims can only be made in the Superior Court, so you will need a lawyer to assist you in a tort claim.  Many times, a Paralegal will work on the SABS and assist a lawyer in preparing the file for a tort action, so there is a lot of cooperation between both professionals.

Q.     What if the Insurance Company refuses to pay for med-rehab or any other benefit I apply for?

In general, when a claim for med-rehab is made, a treatment plan must be submitted by whoever it is that will be providing the service to you.  The insurance company reviews the claim and decides if they will pay. Usually, early in the process, there is less difficulty in getting coverage for these services.  Later, the insurance company may wish to send you to an independent assessor, who is usually a health professional in the same discipline as your service provider, who will determine if continuing to pay for further treatments (or even if a different benefit such as Income Replacement Benefits are still needed).  In response to the report, the insurance company will make this decision. You will be notified before you are “cut off”.

Q.      Can I get my benefits reinstated?

There are a number of ways to do this.  One is getting one of your own providers to complete a comparable assessment to the one done by the insurer’s assessor, and discussions can be targeted if there are differing opinions. Another way is to formally mediate your application.  For most of these  actions, it is best to have representation to assist you in these steps, and to advise you of your options.

Q.     What if the insurance company still doesn’t pay?

As described above, a formal mediation application can be filed.  In many cases, your issues can be resolved fully, or in part at Mediation.   In some cases, I have been able to informally settle the file with the insurer, even when mediation failed.  If mediation still does not resolve the issue, you may need to file a lawsuit against your insurance company or take the matter to arbitration.  My office can handle the arbitration process, if you choose to go in this direction.  Again, mediation and arbitrations have strict time frames, so it is important to file applications on time.

Q.      Is it always advisable to go to arbitration or court?

This step is like any other litigation.  There are costs and benefits that need to be weighed when deciding what to do, or if you should sue or take the matter to arbitration. Because costs can be assessed against an appellant in either a court or arbitration setting, it is important to discuss this with your legal advisor as to your chances of benefiting from taking it to this next level.