OVERVIEW OF CHANGES TO THE ONTARIO STATUTORY ACCIDENT BENEFITS SCHEDULE EFFECTIVE SEPTEMBER 1, 2010
Changes to the Statutory Accident Benefits Schedule (SABS)
The insurance industry is a powerful lobbyist in Ontario and in Canada. In Ontario, the recent changes to the Statutory Accident Benefits Schedule (SABS) which came into effect September 1st, 2010 are an example of the insurance industry’s influence. The changes to the SABS constitute a significant reduction to accident benefits available to victims of minor and non-catastrophic injuries in the Province of Ontario.
This is a brief summary of some of the changes that affect the rights of injured persons in Ontario
Reduction in Non-Catastrophic and Minor Injury Benefits
New Minor Injury Guidelines and Benefits
The new Minor Injury Guidelines is also s significant reduction in benefits available to Ontario car accident victims. The changes include the reduction of the maximum benefit from $100,000.00 to a mere $3500.00. Even worse is that the $3500.00 included medical assessment costs. If you are in the MIG category, you no longer are entitled to covered in-home assessments. Moreover, benefits such as attendant care, housekeeping and caregiver expenses have been eliminated entirely for this category of injury. This is a significant reduction of benefits that will likely hurt Ontario car accident victims and their families.
The $3500.00 maximum is allotted in very specific amounts over three and four-week blocks, with fixed fees for health practitioners. Only $2200.00 of the total is pre-approved.
There are some few exceptions: The test of “compelling evidence”. If an injured person as a pre-existing medical condition which affects his or her ability to reach full recovery within that $3500 limit, the car accident victim may receive additional benefits but only where “compelling evidence” is produced by the victim’s physician. This term “compelling evidence” is undefined and will be the subject of expensive legal proceedings.
The point is clear. Car accident victims with minor injuries in Ontario can reasonably expect considerable resistance in establishing entitlement to more than the allocated $3500.00 benefit.
Whiplash Guideline Merged into Minor Injuries
One significant change to the SABS is the introduction the new Minor Injury Guideline (MIG). This new guideline replaces the previous Pre-Approved Framework Guideline for Grade I and II Whiplash Associated Disorders. The Financial services Commission of Ontario (FSCO) introduced the Minor Injury Guidelines as a transitional change. However, more changes could be coming for Ontario car accident victims.
The new SABS defines a minor injury as a “sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae”. Sequelae means any symptoms that are associated with the listed injuries of sprains, strains, whiplash associated disorders, contusions, abrasions, lacerations or subluxations.
New Non-Catastrophic Injury Benefits
There are also changes to Ontario car accident victims who suffer non-catastrophic injuries which do not fall within the MIG. In these cases, medical and rehabilitation coverage has been reduced from $100,000.00 to $50,000.00. Also, attendant care coverage has been reduced from $72,000.00 to $36,000.00. Policy holders can purchase more coverage under these headings from their car insurance company, but now at an additional cost. The financial limits include the cost of preparing and providing assessments. However, assessments coverage has been limited to $2000.00 under the regulation.
For non-catastrophic injuries, Ontario car accident victims no longer have caregiver, housekeeping and dependent care benefits available, unless they purchased optional insurance from their motor vehicle insurer.
Reimbursement of Expenses – Expenses must be “Incurred”
The new SABS provides that “all reasonable and necessary expenses incurred by or on behalf of the insured person” are covered. However the definition of ‘incurred’ benefits has narrowed significantly, to include situations where the benefit has already been paid, promised to pay or liable to pay, and then only to those providers who conduct such services professionally, or who incur losses as a result of providing such services.
This has an impact on victims who receive care from their family members. In these cases, insurance companies could argue that the injured person has not “incurred” any direct losses. Compare that to the more wealthy victims in Ontario who can afford to pay for services up front and then seek reimbursement; clearly the service cost has been “incurred” in such cases. The new regulation can result on harsh consequences for the less fortunate financially speaking.
Tort Deductible Eliminated in Fatality Cases
One positive change is the elimination of the $15,000.00 tort deductible on awards granted to family members in fatality cases. New options have also been added to reduce tort deductibles in non-fatal claims.
Income Replacement Reduced
Under the new SABs, income replacement benefits are now calculated as 70% of gross income, to a maximum of $400 a week. Previously, it was calculated on the basis of 80% of net income.
WARINING – NOT LEGAL ADVICE : This document is provided for information purposes only and is not legal advice. The law changes regularly and each case is different. One single fact can change legal interests and entitlements significantly. Always consult a lawyer before making any decision. Keep in mind that there are limitation periods in Ontario and you can lose your right to commence legal action and claim compensation and/or benefits if you fail to meet any limitation period applicable to you.