Understanding No-fault Benefits in Ontario – Are my Medical Expenses Covered?

Getting timely and appropriate medical treatment following an injury in a motor vehicle accident is a priority for most drivers in Ontario.   Who pays for this treatment is an important question that needs to be addressed in order reduce anxiety for car accident victims at an already difficult time.

Who pays for my medical treatment after a car accident in Ontario?

The short answer, it depends. Certain medical expenses will be covered by the Ministry of Health and Long-term Care, others may be covered by private insurance, others will be covered under the no-fault scheme in Ontario while others can only be recovered from the at-fault party in a civil action (in certain limited situations).  Today, we are going to talk about those expenses that should be covered under the SABS and the reduced amounts available under the Standard Auto Policy with the introduction of the new SABS in September of 2010.

What Medical Benefits are Covered under the SABS?

According to Ontario accident legislation, the insurance company will pay for all reasonable and necessary medical and rehabilitation expenses incurred as a result of an impairment as a result of a motor vehicle accident.

Examples of the types of expenses covered include:

• chiropractic services
• physiotherapy services
• psychological services
• medications
• transportation to and from treatment sessions.

Of course, there are restrictions, qualifications and procedures which must be followed in order to access these benefits. These are set out in great detail in the SABS legislation as well as in the accompanying Guidelines and Bulletins.

In general however, the following comments apply if a Standard Auto Policy has been purchased:

• For injuries which are covered by the Minor Injury Guideline , a maximum of $3,500.00 is payable for all medical and rehabilitation treatments, including the costs of any assessments and reports. In order to access these benefits an OCF-23 Treatment and Confirmation Form (PDF) needs to be submitted.

• For non-catastrophic, non-minor injuries, a maximum of $50,000.00 is payable for medical and rehabilitation treatments, including the costs of any assessments and reports. In order to access these benefits an OCF-18  Treatment and Assessment Plan needs to be submitted.
• For catastrophic injuries, a maximum of $1,000,000.00 is payable for all medical and rehabilitation treatments, including the costs of any assessments and reports. In order to access this limit, an OCF-19  Application for Determination of Catastrophic Impairment must be submitted.

• If  you have access to a private or group insurance plan (e.g. from work) which may cover the costs associated with any particular treatment, you must try to get those expenses paid by that insurance before your no-fault insurance company will consider paying them.

• You cannot receive both WSIB and no-fault benefits for medical treatment following a car accident. Read more about whether or not the WSIB system applies in our previous blog post , “Injured  on the Job – Can I Sue for Personal Injury Damages?”

Knowing how to get your medical expenses covered following a car accident is vital and can affect your financial well-being.  In addition to your medical expenses, you may have other questions about how the Ontario no-fault benefits system works. Read our previous posts in this series to learn more about:

• Understanding  no-fault benefits in Ontario

• Understanding  no-fault benefits in Ontario – Standard vs. Optional Benefits

• Understanding  no-fault benefits in Ontario- Minor Injury Guideline

Our team of experienced Ontario personal injury lawyers have the expertise to ensure you are accessing all the no-fault benefits available to you and would be pleased to speak with you one on one to answer any questions you may have about getting your medical expenses paid.

Call 1-800-563-6348 or contact an Ontario Injury Lawyer today.