Do I Qualify for Income Replacement Benefits?
Being injured in a motor vehicle incident is scary. But what’s even scarier is the fear that you won’t be able to return to work and continue to provide for you and your family. Whether you’re off work for a few days or a few months, it’s important to think about how the bills will get paid during your period of recovery.
If you have been involved in a car accident and are unable to work, there is a good chance you may be able to receive Income Replacement Benefits (IRBs) under the Statutory Accident Benefits Schedule – Accidents on or after September 2, 2010.
IRBs are available to personal injury victims who were employed at the time of their motor vehicle accident (including self-employed persons) and who, as a result of injuries sustained in the accident, “suffer a substantial inability to perform the essential tasks of their employment.” This is the definition that applies for the first two years following a car accident. After two years, the test changes and it becomes harder to qualify for IRBs. Specifically, the definition after two years is “a complete inability to engage in any employment or self-employment for which he or she is reasonably suited by education, training or experience.”
How do I apply for income replacement Benefits?
In order to receive IRBs, you will need to submit a completed Application for Accident Benefits. In addition, your insurance company will likely require that some, or all, of the following forms, be completed:
- OCF-3 (Disability Certificate)
- OCF-2 (Employer’s Confirmation Form)
- OCF-10 (Election of Income Replacement, Non-Earner or Caregiver Benefit)
How much income replacement will I receive?
If you are eligible to receive IRBs, the amount you receive will depend on a number of factors, including your pre-accident income, any other income available to you, and whether you have purchased Optional Benefits. Key information about IRB payments:
- No IRBs are payable in the first 7 days following an accident
- For accidents occurring after September 1, 2010, the amount of the weekly IRB is based on 70% of your gross pre-accident weekly income, subject to the maximum amounts
- Under the Standard Limits, the maximum weekly amount payable for the first two years following the accident is $400 per week
- Optional benefits increase the maximum weekly amount to $600, $800 or $1,000 per week (must be purchased prior to the date of the car accident)
When do income replacement benefits start?
If an insured is an employee then Income replacement benefits start once the insurer has received a completed disability certificate, employers confirmation of income and is convinced that the insured meets the test for disability and suffers a substantial inability to perform their own occupation. If an insured is self-employed then the process can take much longer as the insurer will usually hire a forensic accountant to review the financial records of the business and determine what the income replacement benefit should be. If a benefit is later determined to be payable the insurer will backdate the first payment to 7 days after the motor vehicle accident, if that is when the disability began.
How long do income replacement benefits last?
Income replacement benefits last as long as the insured meets the test for disability.
The test for disability changes two years post-accident. For the first two years, post-accident the test is that the insured is substantially disabled from their own occupation. After that time period, an insured will only continue to be entitled to the benefit if they are completely disabled from all occupations they are reasonably qualified for.
Can my insurance company stop my Income replacement benefits?
An insurer can terminate an IRB if they have evidence that the insured no longer meets the appropriate test for disability.
An insurer can also terminate an IRB for an insured’s failure to cooperate. For example not providing an updated disability certificate upon request.
What happens to IRB after the age of 65?
Beyond 65 IRBs continue but are reduced based on a formula set out in the regulations.