Specified Benefits

For the purposes of the accident benefits claim, the term “specified benefits” refers to an income replacement benefit, a non-earner benefit, a caregiver benefit or a payment for housekeeping or home maintenance services.

Income replacement and non-earner benefits may be accessed by an injured person regardless of the type of impairment suffered in an accident. However, unless the applicable optional benefits were purchased, the caregiver benefit and the housekeeping and home maintenance benefit may only be accessed by those who suffer a catastrophic impairment as a result of an accident.

If an injured person was employed or self-employed at the time of the accident and suffers a substantial inability to perform the essential tasks of that employment within 104 weeks after the accident, then they will be eligible to receive an income replacement benefit.

Even in cases where an injured person was not employed at the time of the accident, there is still the possibility that a claim for an income replacement benefit may be pursued. Such a claim may be paid in the event that the injured person was employed for at least 26 of the 52 weeks prior to the accident, or was receiving benefits under the Employment Insurance Act at the time of the accident. In the event that such a person suffers a substantial inability to perform the essential tasks of the employment in which they spent most of their time in the 52 weeks before the accident, then the claim will be payable.

Payment of an income replacement benefit may continue beyond 104 weeks of disability if the injured person suffers a complete inability to engage in any employment or self-employment for which they are reasonably suited by education, training, or experience.

The amount of income replacement benefit is 70 per cent of the injured person’s average pre-accident gross earnings to a maximum of $400 per week. No income replacement benefit is payable with respect to any earnings not declared on income tax returns. If optional benefits were purchased on the policy of automobile insurance, it is possible that the maximum income replacement benefit will be increased to as high as $1,000 per week depending on the extent of the average gross pre-accident income. In the instance that an injured person has an income replacement benefit entitlement of less than $185 per week, and in the event that they remain eligible to receive the benefit after 104 weeks of disability, then the amount of benefit will be raised to $185 per week.

Subject to certain criteria and calculations, the injured person’s entitlement to an income replacement benefit will be reduced by post-accident employment earnings as well as by any other available income replacement assistance.

Determining an injured person’s entitlement to an income replacement benefit can be difficult and insurance adjusters are not always accurate in the performance of such calculations. To name a few complex circumstances, it can be particularly difficult to determine the income replacement benefit entitlement for self-employed persons, for those who work in gratuity-based service professions, and for those who have more than one income source. It is of the utmost importance that an injured person’s claim for an income replacement benefit be accurately assessed. Consulting with an experienced personal injury law firm is recommended in order to ensure that the income replacement benefit is appropriately determined by the insurance adjuster.

If an injured person does not qualify to receive an income replacement benefit, then it is possible that a non-earner benefit will be paid. This benefit may also be available to full-time students, or to students who have completed their education in the past year, but have not obtained employment reflective of that education and training.

To be eligible to receive a non-earner benefit, the injured person must have suffered a complete inability to carry on a normal life as a result of and within 104 weeks of an accident. Non-earner benefits are not payable for the period before the injured person attains 18 years of age.

Following a four week waiting period, the benefit will be paid at a rate of $185 per week. This benefit is only available within the first 104 weeks from the date of the accident. These amounts are reduced by any other payment received or available to the person for loss of income.

The caregiver benefit will reimburse a catastrophically impaired person for expenses incurred if, as a result of and within 104 weeks after the accident, they suffer a substantial inability to engage in their usual pre-accident caregiving activities. This benefit may also be made available to those who suffer non-catastrophic impairment if an optional benefit was purchased on the policy of automobile insurance.

In order to be eligible to receive a caregiver benefit, the injured person must have lived with the person in need of care at the time of the accident and must also have been the primary caregiver to that person without having received any remuneration for providing the care.

For the purposes of this benefit, a person in need of care means a person who is under 16 years of age or who requires care because of physical or mental incapacity.

The caregiver benefit will cover reasonable and necessary expenses incurred but will be limited to a maximum of $250 per week for the first person in need of care and an additional $50 per week for each additional person in need of care.

The caregiver benefit may be paid beyond 104 weeks of disability if, as a result of the accident, the injured person suffers a complete inability to carry on a normal life.

In the event that an injured person may qualify to receive more than one of the income replacement, non-earner and caregiver benefits, the injured person will have to make an election as to which benefit will be received. This is because only one of these benefits may be received in relation to a given accident.

Once an insurer gives notice of the requirement for an election to be made, the injured person has 30 days to make the election. To further complicate the matter, an election of benefit is final once made, regardless of any changes in circumstance. The only time that a re-election of benefit may be made is when an insurer gives notice of acceptance of an application for catastrophic impairment.

Deciding which benefit to elect is an important decision and such a choice can have significant financial impact and repercussion. Given the importance of the election decision, it is in the interests of an injured person to consult a legal professional with high-level experience in accident benefits upon receiving a notice of requirement to make an election of benefits.

The insurer will pay up to $100 per week for reasonable and necessary additional expenses incurred by an injured person as a result of an accident for housekeeping and home maintenance services.

To be eligible to receive this benefit, the injured person must have suffered a catastrophic impairment that results in a substantial inability to perform the housekeeping and home maintenance services that they normally performed before the accident. The housekeeping and home maintenance benefit may also be available to those who suffer a substantial inability to perform their usual pre-accident tasks if optional benefits were purchased on the policy of automobile insurance. Otherwise, those who suffer non-catastrophic impairment are not entitled to this benefit.