Automobile insurance policy 101: Mandatory and optional accident benefits coverage

Mandatory accident benefits coverage

Optional accident benefits coverage

Medical, rehabilitation and attendant care benefits

Allow claims to access to some treatments not covered by OHIP (e.g. physiotherapy, chiropractic treatment, etc.), claims for mobility devices (e.g. wheelchairs) and claims for assistant care (e.g. assistance from a personal support worker for activities of daily living).

Typically, the quantum of benefits is capped at $65,000 for serious non-catastrophic injuries, and $1,000,000 for catastrophic injuries.

Generally, the optional benefits increase the quantum of benefits claimable to $130,000 for serious non-catastrophic injuries and up to $2,000,000 for catastrophic injuries. Even further benefits are available under this category.

Caregiver benefits

This benefit may be claimed by those who, at the time of the accident, provided full-time care for a dependant (e.g. children and aging parents) residing with them, and, due to the collision, can no longer provide such care requiring that they hire help.

Generally, the injured person must have suffered catastrophic injuries in a motor vehicle collision to claim this benefit.

The injured person is not required to have suffered catastrophic injuries to claim this benefit.

Income replacement benefits

Generally claimable for an amount of up to $400/week.

Depending on the policy, the amount claimable as income replacement benefits can be up to $1,000/week.

Housekeeping and home maintenance benefits

This benefit covers the costs of hiring someone to perform housekeeping and/or home maintenance tasks that the injured person used to perform prior to the collision.

Normally claimable only by those who, as a result of the collision, have been catastrophically injured.

This benefit is not exclusive to individuals who were catastrophically injured in a collision.

Death and funeral benefits

This benefit is claimable in the event the insured dies as a result of the motor vehicle collision.

The benefit provides up to $25,000 for the eligible spouse, up to $10,000 to each eligible dependant, and a maximum of $6,000 for funeral expenses.

The benefit is usually capped at $50,000 for the eligible spouse, $20,000 to each dependant, and $8,000 for funeral expenses.

Indexation

This benefit provides annual adjustment for inflation to other benefits such as income replacement, non-earner benefit, medical, rehabilitation and attendant care benefits.

This benefit is not part of the mandatory accident benefits policy.

This benefit can be contracted as an optional benefit.

Dependant care benefits

This benefit covers those who were employed at the time of the collision and as a result of the injuries sustained in the accident had to pay for additional childcare expenses.

This benefit is not part of the mandatory accident benefits policy.

Typically, a dependant care benefit claim may cover up to $75/week for the first dependant and $25/week for each additional dependant, to a maximum amount of $150/week.