Car Accident Benefits (after June 2016)

For those that have purchased their car insurance policy after June 1, 2016, and the car accident occurred after June 1, 2016.
1.	Does the injured person have to be in a car to be eligible for accident benefits?
2.	Are accident benefits paid automatically after the injured person has a car accident?
3.	Can the injured person apply for accident benefits after the 30 day deadline?
4.	What documents have to be submitted to the car insurer?
5.	Is the injured person the only person covered by Statutory Accident Benefits in a car accident?
6.	Which car insurance company does the injured person notify?
7.	What if there is no car insurance policy available?
8.	What if the injured person has private medical benefits?
9.	What is the injured person’s car insurer required to pay?
10.	How much is the injured person entitled to receive in accident benefits?
11.	What does the injured person need to submit to the car insurer?
12.	What is a minor injury?
13.	How does the car insurer approve treatment?
14.	Do medical assessments affect the amount of my medical and rehabilitation benefits?
15.	Is the injured person’s car insurer required to pay for an aide or attendant?
16.	How much can the injured person receive for attendant care?
17.	Can the injured person arrange for their own medical or rehabilitation assessment to determine what treatment the injured person requires?
18.	When is the injured person entitled to receive weekly income replacement benefits?
19.	What is the test for continuing to receive income replacement benefits?
20.	What about where the injured person has some undeclared income?
21.	When can the injured person begin receiving income replacement benefits?
22.	What is the maximum amount of income replacement benefits the injured person can receive?
23.	Can self-employed persons receive income replacement benefits?
24.	How long can the injured person receive income replacement benefits?
25.	When is the injured person entitled to receive non-earner benefits?
26.	What is the maximum amount of non-earner benefits an injured person can receive?
27.	Can an injured person receive caregiver benefits?
28.	What is the maximum amount of caregiver benefits the injured person can receive?
29.	Can the injured person receive income replacement benefits, non-earner benefits and caregiver benefits at the same time?
30.	What if the injured person is self-employed and also a "caregiver"?
31.	When can the accident benefit insurer stop payment of the injured person’s weekly benefits?
32.	Will attempting to return to work affect the injured person’s weekly benefits?
33.	Is the injured person’s accident benefit insurer required to pay for funeral expenses?
34.	Is the injured person’s accident benefit insurer required to pay death benefits?
35.	What do optional death and funeral benefits provide?
36.	How to qualify for death benefits?
37.	Who is entitled to receive payment for visiting expenses?
38.	When is the injured person entitled to receive payment for lost education expenses?
39.	What is the maximum amount the injured person can receive for lost education expenses?
40.	What is the maximum amount the injured person can receive for housekeeping and home maintenance expenses?
41.	How long can the injured person receive payment for these expenses?
42.	What other expenses can the injured person receive payment for from the accident benefit insurer?
43.	What is a catastrophic impairment?
44.	What if the injured person’s injury is determined to be catastrophic, as defined by the insurance Act?
45.	Can the insurer require the injured person to go to the insurer’s doctor or other health care worker for a physical or psychological examination?
46.	When is the injured person’s accident benefit insurer not obligated to pay benefits?
47.	What if the injured person has optional benefits?
48.	What if the injured person has a dispute with the accident benefit insurer?
49.	Does the injured person need a lawyer for any dispute with the injured person’s accident benefit insurer for accident benefits?
50.	What happens when the accident benefit insurer offers to settle the injured person’s accident benefit claim?

Answers

1.	Does the injured person have to be in a car to be eligible for accident benefits?
A.	Pedestrians and cyclists may also be entitled to accident benefits. Accident benefits are available to everyone who is injured directly as a result of a car accident. Accident benefits are also available to the driver of the car, regardless of who is at fault for the car accident.
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2.	Are accident benefits paid automatically after the injured person has a car accident?
A.	No. The injured person must notify their car insurer within 7 days or as soon after as is practicable of the accident that the injured person wishes to apply for accident benefits. The injured person’s car insurer must then promptly give the injured person application forms. If the injured person is a passenger in the car then they must notify their own car insurer even though their car was not involved in the car accident. The injured person must file the completed application forms with their accident benefit car insurer within 30 days after receiving them from the car insurer.
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3.	Can the injured person apply for accident benefits after the 30 day deadline?
A.	Most car insurers will accept later applications if the injured person has a reasonable explanation for the delay ( i.e. in the hospital for an extended stay due to the injuries from the car accident). However it is always best to meet the 30 day time limit. No benefit is payable by the car insurer until a complete application is sent and approved by the car insurer.
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4.	What documents have to be submitted to the car insurer?
A.	The injured person should notify their car insurer, or the insurer that is responsible for providing the injured person with accident benefits, and request an Application for Accident Benefits. There is a standard application package. The documents can also be obtained from the Financial Services Commission of Ontario website www.fsco.ca/en/auto/forms/Pages/ocf_forms.aspx. The documents are not difficult to complete. If the injured person is unsure about completing the documents then one of our personal injury lawyers or accident benefit specialists can be consulted to assist in completion of the documents.
	If the injured person is unsure as to which car insurer to submit the documents to, they can send them to the car insurer they think is appropriate to start the accident benefit process and the car insurance company will sort out who the appropriate company is. The injured person’s access to medical and rehabilitation benefits will not be interrupted while the car insurers try to sort out which company is responsible.
	The injured person must also consent to the disclosure of medical information and/or loss of income information to the car insurer. This may involve signing waivers to permit the car insurer to obtain this information directly from the injured person’s doctor and/or employer. It is important to cooperate with the insurance company that is providing the injured person with accident benefits. The accident benefit is entitled to full disclosure regarding the injured person’s medical information. The failure to provide medical information, or access to medical information in a timely manner could result in the termination or suspension of accident benefits.
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5.	Is the injured person the only person covered by Statutory Accident Benefits in a car accident?
A.	No. Any member of the injured person’s immediate family may also be entitled to recover benefits if the family member suffers psychological or mental injury as a result of the injured person’s accident. For example, where a child is severely injured in a car accident the injured person’s parent may require counseling to assist in dealing with the emotional trauma connected with providing ongoing support to a severely injured child.
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6.	Which car insurance company does the injured person notify?
A.	The person injured in a car accident will be required to notify their own car insurance company to apply for accident benefits. This will not affect car insurance rates. If the injured person does not have car insurance then they would next apply to the car insurance company that covers any person that they are dependant upon. For example, a child in another person’s car would contact their parents’ car insurer to apply for accident benefits. If the injured person does not have access to any other car insurance then they will likely have to apply to the car insurance company that is covering the car they are in at the time of the accident. If the injured person is a pedestrian at the time of the accident, they would go through the same process as above and ultimately, if they do not have access to any car insurance policy, then they could apply to the car insurance company for the vehicle that struck them.
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7.	What if there is no car insurance policy available?
A.	In the event that there is no car insurance coverage, then an application for accident benefits can be made to the Motor Vehicle Accident Claim Fund. This fund is operated by the Ontario government and is to provide coverage to injured persons where no coverage is available. In most cases the medical and rehabilitation coverage is the same as if there was a car insurance policy available.
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8.	What if the injured person has private medical benefits?
A.	Car accident benefits only pay for medical expenses which are not covered by some other private policy or employment benefit plan. If these other benefit plans cover only part of the expenses then the injured person’s car accident benefits will, in most cases, pay the balance.
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9.	What is the injured person’s car insurer required to pay?
A.	The car insurer may be required to pay all of the reasonable expenses incurred as a result of the injured person’s accident, including but limited to:
	medical, hospital, attendant and nursing care, chiropractic, psychological, massage and occupational therapy, medication, prescription eyewear, dental devices and medical aids, transportation to and from treatment sessions where the distance travelled exceeds 50 kms to and from the treatment provider, social and vocational rehabilitation and retraining, home renovations and vehicle modifications, housekeeping and home maintenance.
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10.	How much is the injured person entitled to receive in accident benefits?
A.	For those people suffering from “minor injuries” as a result of the car accident, then they are entitled to receive up to $3,500.00 in medical and rehabilitation benefits and services.
	Where the injured person’s injuries are not considered to be catastrophic, then the injured person is entitled to receive up to $ $65,000 total for medical, rehabilitation and attendant Care (for Non-Catastrophic Injuries), including assessment costs for a duration of 5 years. An individual may purchase optional coverage providing for the increase in the level of medical and rehabilitation benefits to $130,000.00 for a duration of 5 years, or up to $1,000,000.00 for a lifetime duration. Note that optional coverage will not increase the medical and rehabilitation benefits for those suffering from a minor injury.
	If the injured person’s injury is catastrophic as defined by the Statutory Accident Benefit Schedule, the catastrophically impaired car accident victim is entitled to receive $1,000,000 total for medical, rehabilitation and attendant care. Optional coverage for an additional $1,000,000.00 can be purchased for medical, rehabilitation and attendant care benefits including assessment costs.
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11.	What does the injured person need to submit to the car insurer?
A.	In order to obtain access to the medical and rehabilitation benefits under the accident benefits, a Treatment Plan has to be submitted to the insurance company on behalf of the injured person. This will be done by the treatment provider (i.e. physiotherapist or chiropractor). This should be done before any treatment commences. The treatment plan must be prepared by a health professional and signed by an authorized health practitioner (i.e. physician, chiropractor or physiotherapist).
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12.	What is a minor injury?
A.	A minor injury is defined by the Statutory Accident Benefits as a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae. If a car accident victim suffers from a minor injury then treatment is provided under the Minor Injury Guideline. The Guideline establishes a treatment framework in respect of one or more minor injuries.
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13.	How does the car insurer approve treatment?
A.	Car insurers are entitled to refuse to pay for treatment unless a treatment plan is completed. If a treatment plan is denied by the insurer, then there is an appeal process which provides for an insurer’s examination (IE) to assess whether the treatment plan is reasonable and necessary. If the IE determines that the treatment plan is reasonable and necessary, then the car insurer will approve the treatment. If the IE determines that the recommended treatment is not reasonable and necessary then there is a detailed appeal process that includes a responding medical assessment, mediation and arbitration.
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14.	Do medical assessments affect the amount of my medical and rehabilitation benefits?
A.	The Statutory Accident Benefits provide that medical and rehabilitation benefits payable in respect of a car accident victim will include all fees and expenses for conducting assessments and examinations and preparing reports in connection with any benefit or payment to or for an insured person under this Regulation.
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15.	Is the injured person’s car insurer required to pay for an aide or attendant?
A.	When the injured person has been injured in an car accident their car insurer may be required to pay the cost of providing for an aide or attendant. These benefits include the services of the injured person’s family members caring for the injure person at home or even at the health institution where the injured person is receiving treatment and recovering. The injured person must “incur” the expense of the attendant care. In order to be reimbursed, the person providing the attendant service must do so as a result of their usual employment or where the person providing the service, such as a family member, will have suffered an economic loss to provide the service. There are specific forms that must be completed by an occupational therapist or a physician before the attendant care will be paid by the car insurer.
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16.	How much can the injured person receive for attendant care?
A.	Where the injured person is not considered to be catastrophically impaired, then they can receive up to $65,000 total for medical, rehabilitation and attendant care. Where the injured person has purchased optional coverage then they may receive a total of $130,000 for medical, rehabilitation and attendant care.
	If the injured person is determined to be catastrophically impaired, they can receive up to a maximum of $1,000,000.00 for medical, rehabilitation and attendant car. They many increase this to a total of $2,000,000.00 with optional coverage.
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17.	Can the injured person arrange for their own medical or rehabilitation assessment to determine what treatment the injured person requires?
A.	Yes. The injured person’s own treating health care specialists can perform an assessment under the regulation and where completed in accordance with the accident benefit guidelines, the car insurer is obligated to pay for the cost of that assessment. The injured person does not have to obtain a referral from their family doctor prior to attending at a treating facility ( i.e. a physiotherapist, chiropractor or massage therapist). The injured person can attend the facility of their choice to have an assessment completed and treatment. The injured person just has to ensure that before treatment has started it is approved by the car insurer, unless they are dealing with a WAD I or WAD II injury.
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18.	When is the injured person entitled to receive weekly income replacement benefits?
A.	The injured person is entitled to receive weekly income replacement benefits (IRBs) for up to the first 104 weeks of disability (excluding the first week) after a car accident in any of the following circumstances:
	the injured person was employed on the date of the accident and thereafter suffered a substantial inability to perform the essential tasks of their employment,
	the injured person was not employed at the time of the accident but worked at least 26 of the 52 weeks before the accident and then suffered a substantial inability to perform the essential tasks of the employment in which the injured person spent most of their time during the 52 weeks before the car accident,
	the injured person was entitled to start work within one year under a legitimate written contract that was made before the car accident and as a result of the car accident the injured person suffers a substantial inability to perform the essential tasks of their pre car accident employment.
	Currently the maximum benefit is 70% of gross income up to $400/week. Optional benefits may be purchased to increase the amount to $600, $800 or $1000 per week. You should look closely at your current income to determine the required need.
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19.	What is the test for continuing to receive income replacement benefits?
A.	The injured person is entitled to receive income replacement benefits for the first 104 weeks after the accident when they suffer a substantial inability to perform the essential tasks of their employment at the time of the car accident. The test changes after 104 weeks and the injured person will continue to receive income replacement benefits where the injured person is suffering a complete inability to engage in any employment for which they are reasonably suited by education, training or experience.
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20.	What about where the injured person has some undeclared income?
A.	The injured person’s income replacement benefits are calculated based on declared income. If the injured person received cash payments or tips ( i.e. tradesperson or waiter) and did not declare that income for income tax purposes, then those amounts will not be factored in for the calculation of income replacement benefits by the car insurer unless the car accident victim has his income tax returns resubmitted to account for previously undeclared income.
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21.	When can the injured person begin receiving income replacement benefits?
A.	The injured person will not receive income replacement benefits for the first 7 days after a car accident. Then, as long as the injured person qualifies, they can receive 70% of their gross weekly income up to a maximum of $400.00 per week, unless you purchase optional coverage for increased weekly benefits.
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22.	What is the maximum amount of income replacement benefits the injured person can receive?
A.	The injured person can receive a maximum of $400.00 per week. If optional car insurance coverage was purchased, they can receive up to a maximum of $1,000.00 per week. If the injured person is entitled to Group Benefits or private disability benefits they may still be entitled to income replacement benefits in addition to the group or private disability benefits. The car insurer will prepare a calculation of income replacement benefits payable. Car insurance regulations provide the formula for calculating the amount of income replacement benefits payable and how to account for any other income received by the injured person. As long as the car accident victim qualifies, then they can receive 70% of their gross weekly income. This amount is reduced by any benefits that the car accident victim receives from another insurance policy or employment plan.
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23.	Can self-employed persons receive income replacement benefits?
A.	Yes. Self-employed persons are entitled to income replacement benefits depending on their income and expense situation. In most cases an accountant will be necessary to provide the car insurer with the necessary financial documentation to allow the car insurer to calculate the amount of income replacement payable to the self employed person. It is important the self employed person maintain accurate and up to date financial records.
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24.	How long can the injured person receive income replacement benefits?
A.	Income replacement benefits are payable, where the injured person qualifies, up until age 65 and then the income replacement benefits start to reduce on a gradual basis.
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25.	When is the injured person entitled to receive non-earner benefits?
A.	If, at the time of the car accident, the injured person was not working but was enrolled in school or had completed their education during the year prior to the car accident and were not employed in a job that reflected their education, they may be entitled to a non-earner benefit. The injured person is only entitled to this benefit if they suffer a complete inability to carry on a normal life and are over 16 years of age.
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26.	What is the maximum amount of non-earner benefits an injured person can receive?
A.	The amount of the non-earner benefit (NEB) is $185.00 per week. However, nothing is payable for the first 4 weeks after the car accident. If the injured person is completely unable to carry on a normal life then the NEB is paid for a maximum of 2 years.
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27.	Can an injured person receive caregiver benefits?
A.	Caregiver benefits are no longer available to an injured person unless they are deemed Catastrophically Impaired under the insurance policy. If the injured person is Catastrophically Impaired, and they are substantially unable to participate in caregiving activities, then a caregiver benefit can be paid.
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28.	What is the maximum amount of caregiver benefits the injured person can receive?
A.	The maximum amount of the caregiver benefit payable for a person that is catastrophically impaired is $250.00 per week for the first person in need of care plus $50.00 per week for each additional person. If the injured person had purchased optional coverage then that person can receive a caregiver benefit regardless of whether they are catastrophically impaired or not, as long as they qualify as noted above. Optional coverage may be purchased to increase your benefit to up to $250/week for the first dependant and $50/week for each additional dependant for all injuries.
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29.	Can the injured person receive income replacement benefits, non-earner benefits and caregiver benefits at the same time?
A.	No. The injured person can only receive one of the income replacement, non-earner and caregiver benefits payable for any given period of time. An election is made by the injured person at the time that accident benefits are applied for. You should consult a personal injury lawyer to review your options.
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30.	What if the injured person is self-employed and also a "caregiver"?
A.	The injured person can only elect to receive one income benefit. Advice from one of our personal injury lawyers will assist to help the injured person make the correct decision. In certain circumstances an election of one type of income benefit may be changed for another income benefit.
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31.	When can the accident benefit insurer stop payment of the injured person’s weekly benefits?
A.	An accident benefit insurer may stop payment of weekly benefits in the following circumstances:
	if the accident benefit insurer requires a certificate from a health practitioner stating that the injured person continues to suffer from the disability, the accident benefit insurer may stop payment of weekly benefits after 21 days of its request for that certificate if the certificate is not provided,
	if the accident benefit insurer requires the injured person to be assessed by a health practitioner of its choice, the report produced by this practitioner must be provided to the accident benefit insurer and the accident benefit insurer must forward the injured person a copy within 7 days. If the report states that the injured person is no longer suffering from the disability the accident benefit insurer may stop payment of the weekly benefits and then the injured person will have to access the dispute process provided in the insurance legislation.
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32.	Will attempting to return to work affect the injured person’s weekly benefits?
A.	The injured person may attempt to return to work at any time during the first 104 weeks after the car accident without affecting the injured person’s entitlement to start receiving income replacement benefits if the injured person cannot continue with their employment because of the accident.
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33.	Is the injured person’s accident benefit insurer required to pay for funeral expenses?
A.	When an insured person dies as a result of a motor vehicle accident, the accident benefit insurer may be required to pay funeral expenses incurred to a maximum of $6,000.00. Optional coverage may be purchased to increase the coverage to a maximum of $8000 for the funeral.
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34.	Is the injured person’s accident benefit insurer required to pay death benefits?
A.	If the deceased car accident victim was married, a sum of $25,000.00 would be payable to his or her spouse. If the deceased car accident victim was not married but was survived by a dependant(s), the $25,000.00 is divided equally among the dependants. If the deceased was a dependant at the time of the accident, $10,000.00 would be payable to the person upon whom the deceased was dependant.
	Optional coverage may be purchased to increase the coverage to a maximum of $50,000 for the eligible spouse and $20,000 for each dependant.
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35.	What do optional death and funeral benefits provide?
A.	If the deceased accident victim had purchased optional death and funeral benefits, the benefit for loss of a spouse is $50,000.00, the loss of a dependant is $20,000.00, and a maximum amount of $8,000.00 for funeral expenses could be payable.
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36.	How to qualify for death benefits?
A.	In order to qualify for death benefits, the deceased accident victim must have died within 180 days from the accident, or, if the deceased was continuously disabled as a result of the accident, within 156 weeks of the day of the accident.
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37.	Who is entitled to receive payment for visiting expenses?
A.	If family members and other individuals who were living with the injured person at the time of the car accident visit the injured person, they are entitled to payment of all reasonable and necessary expenses incurred. There is no payment after 104 weeks unless the injured person is catastrophically impaired.
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38.	When is the injured person entitled to receive payment for lost education expenses?
A.	If the injured person is unable to continue in a program that injured person was enrolled in at the time of the car accident, the accident benefit insurer will pay for the lost educational expenses. The car insurer is not required to make any payments after 104 weeks unless the car accident victim is considered to be catastrophically impaired.
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39.	What is the maximum amount the injured person can receive for lost education expenses?
A.	The maximum amount the injured person can receive is $15,000.00. This amount is meant to compensate for expenses incurred before the car accident, such as tuition, books, equipment, and room and board.
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40.	What is the maximum amount the injured person can receive for housekeeping and home maintenance expenses?
A.	The injured person can receive $100.00 per week for all reasonable expenses for housekeeping and home maintenance, if the injured person is considered to be catastrophically impaired and suffers a substantial inability to perform these services and the injured person performed these services before the accident. The car accident victim can receive up to $100.00 per week for reasonably housekeeping and home maintenance expenses, regardless of the injury sustained, if they purchased optional coverage under their car insurance plan and they are substantially unable to perform the services as noted above.
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41.	How long can the injured person receive payment for these expenses?
A.	The injured person’s housekeeping and home maintenance expenses are paid for 104 weeks. If the injured person is considered to be catastrophically impaired, then the housekeeping and home maintenance expenses continue to be paid for the injured person.
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42.	What other expenses can the injured person receive payment for from the accident benefit insurer?
A.	The injured person’s accident benefit insurer may be obligated to replace or repair clothing damaged in the car accident, prescription eyewear, dentures, hearing aids, prostheses, and other medical or dental devices lost or damaged in the car accident.
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43.	What is a catastrophic impairment?
A.	Some examples of catastrophic impairments are paraplegia or quadriplegia, permanent loss of use of one limb, loss of vision in both eyes, and severe brain injuries.
	If the car accident victim does not meet one of these tests, once the injured person’s condition has stabilized or two years has elapsed since the motor vehicle accident, the injured person may make an application to the accident benefit insurer for a determination that the impairment is catastrophic.
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44.	What if the injured person’s injury is determined to be catastrophic, as defined by the insurance Act?
A.	If the injured person’s injury is determined to be a catastrophic impairment as defined by the Insurance Act, then the injured person is entitled to a maximum of $1,000,000.00 for medical rehabilitation and attendant care benefits combined. These benefits are payable over the injured person’s entire lifetime.
	Optional coverage may be purchased to increase this to $1,000,000 for Non Catastrophic injuries and to $2,000,000 for Catastrophic injuries for a total of $3,000,000.
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45.	Can the insurer require the injured person to go to the insurer’s doctor or other health care worker for a physical or psychological examination?
A.	The accident benefit insurer may require an injured person to attend an assessment where the accident benefit insurer is denying a treatment plan. The car insurer may require the car accident victim to attend examinations as often as reasonably necessary. The car insurer may not require the car accident victim to attend an insurance examination where the benefits that the car accident victim are receiving is as a result of a minor injury as provided under the Minor Injury Guidelines.
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46.	When is the injured person’s accident benefit insurer not obligated to pay benefits?
A.	The accident benefit insurer is not obligated to pay income replacement benefits, non-earner benefits, lost education expenses, expenses of visitors or home maintenance expenses if the injured person was the driver of a car at the time of the accident and;
	the injured person knew or ought to have known that the motor vehicle was not insured, the injured person was not licensed to drive, the injured person was an excluded driver under the contract of insurance for the motor vehicle in which the injured person was driving at the time of the accident, the injured person was driving a motor vehicle, or was an occupant of a motor vehicle, when the injured person ought to have known that the motor vehicle was being driven without the owner's consent, the injured person was convicted of impaired driving, the injured person was convicted of driving with a blood alcohol level exceeding legal limits, the injured person was convicted of failing to provide a breath sample, the injured person was engaged in, or was an occupant of an automobile that was being used in connection with a criminal offence, the injured person misstated facts to the accident benefit insurer in order to obtain motor vehicle insurance, the injured person is convicted of a criminal offence or is an occupant of a vehicle being used for the commission of a criminal offence.
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47.	What if the injured person has optional benefits?
A.	If the injured person has purchased optional benefits from their accident benefit insurer, the amount of benefits available to the injured person may be increased. For this reason anyone that owns car insurance should always review their automobile insurance policy. When applying for accident benefits, whether directly with the accident benefit insurer, or with the assistance of a third party, such as a personal injury lawyer, the injured person should review their policy and advise the accident benefit insurer of any optional benefits.
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48.	What if the injured person has a dispute with the accident benefit insurer?
A.	If the injured person is having difficulties recovering the accident benefits the injured person is entitled to, one of our personal injury lawyers should be consulted. Any lawsuit, to enforce the payment of these benefits, must be commenced within two years from the time the accident benefit insurer refused to pay the benefit. Before a lawsuit can be commenced, the dispute will have to be heard at a mediation which is conducted by a mediator with the Licence Appeal Tribunal of Ontario. If the matter is not resolved at mediation, then the injured person has the option of continuing the dispute through arbitration or litigation.
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49.	Does the injured person need a lawyer for any dispute with the injured person’s accident benefit insurer for accident benefits?
A.	A personal injury lawyer can help assess whether the injured person has a potential for a successful resolution of an accident benefit dispute in their favour. A skilled personal injury lawyer will determine whether the injured person is entitled to accident benefits, whether the recommended treatment plan is reasonable and necessary, whether the amounts being paid are correct, and many other legal and medical questions. A skilled personal injury lawyer who acts for accident victims can help with that evaluation, and can help the injured person make the correct decision and insure that they are getting what they are entitled to.
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50.	What happens when the accident benefit insurer offers to settle the injured person’s accident benefit claim?
A.	When the injured person applies for accident benefits, they become an open claim for the accident benefit insurer. This claim remains open for a minimum of 10 years from the date of the accident. If the injured person is later determined to be catastrophically impaired then the financial obligation of the accident benefit insurer increases considerably (see amount available for medical and rehabilitation above). At times, but not before one year after the date of the accident, the accident benefit insurer may approach the injured person about settling their accident benefit claim with the insurer.
	The decision to settle the accident benefit claim will depend on a number of factors including: the amount of treatment that is currently being received by the injured person; the anticipated length of time for treatment to continue; future treatments that may be required ( i.e. massage, physio and chiropractic); any special treatments that will be required in the future ( i.e. pain program); access to any other medical benefit plans available to the injured person; the prognosis for the injury and expected progression of the injury; is there a possibility that the injured person would be considered catastrophically impaired; the dollar amount that is being offered by the insurer.
	There are a number of factors to be considered when deciding whether to “cash out” the injured person’s accident benefit insurance coverage. Everyone’s circumstances are unique and the injured person should consult with one of our personal injury lawyers who can assist in determining whether it is appropriate to consider a settlement of accident benefits and also assist in negotiating an appropriate settlement amount.
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Car Accident Benefits (after June 2016)

For those that have purchased their car insurance policy after June 1, 2016, and the car accident occurred after June 1, 2016.

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