Accidents since November 1, 1996
Almost all accident claims are now under this system:
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Ontario's Conservative Mike Harris Government elected in 1995 brought in the
current auto insurance system effective November 1, 1996. Changes have
been made with legislation (Bill 198) which were partially implemented by
the Eves government up until the day before it lost power in the October 2, 2003
election. The present Liberal Government said they would scrap some of the changes and bring in
another overhaul of the system but that did not appeared on their agenda for
their first term in office. With the passage of time it is likely that
there will be some overhaul brought in during this the second term of the Dalton
McGuinty government. Auto insurance was a major election issue in several
provinces in recent elections as parties tried to get votes by promising an end
to the high premiums and many reforms. We will update this website to include
full information about any future Ontario changes if and when they are
announced. Almost all existing claims are for accidents since November 1, 1996 and are under the system known as Bill 59. Under Bill 59 accident benefits were cut back sharply from the previous NDP system to provide limited rehabilitation, attendant care and treatment benefits unless the injury is "catastrophic". No fault disability benefits were reduced to 80% of net income to a maximum of $400.00 per week. The non-indexed benefit is for up to two years of being unable to perform one's pre-accident job. Benefits for unemployed, students and homemakers do not apply until after six months of disability. It is very difficult to qualify for these non-earner benefits. After two years there is no disability benefits unless a person is unable to engage in any employment for which they are reasonably qualified in which case the benefit would continue. There is optional extra coverage for accident benefits but due to the already high cost of auto insurance few people have been willing to pay more for the additional benefits. You should discuss optional coverage with your broker if you have not done so already as it is not overly expensive as an additional charge to your insurance premium. If you have a dispute with your insurer over accident benefits you must as a first step Mediate with an independent mediator employed by the Financial Services Commission. Under the new law you will not be able to assign your right to mediate to others such as a clinic which wishes to use the system to collect bills from insurance companies. If Mediation fails you may choose to sue in court or go to private arbitration or the more regularly used and very knowledgeable Arbitrators of the Financial Services Commission. Those arbitrators are independent and spend all of their time dealing with accident benefit disputes. There is a $100 consumer fee to apply for arbitration and the insurer pays a much larger fee. The new law restricts the right of non-lawyer representatives (usually paralegals) to represent people making accident benefit claims because of past problems and complaints. They will have to be registered and insured and will not be allowed to represent people who are catastrophically injured. It is usually best to have a lawyer specialized in this area of law represent you.
The right to sue was extended in 1996 under Bill 59 to include economic loss claims but the threshold
for pain and suffering claims was made onerous again with a permanency
requirement. It reads:
The injured person has died or sustained:
a) permanent serious disfigurement; or
This threshold has been liberally interpreted by the courts but changes made by
Ernie Eves as Premier in 2003
just before he lost the election made it tougher as was originally intended. The deductible on pain and
suffering claims has already been raised under Bill 59 from $10,000.00
(indexed to inflation) to $15,000.00
(non-indexed) to further
reduce minor accident claims. Amendments eliminate the deductible for
accidents (after October 1, 2003) from pain and suffering assessments above $100,000 but
otherwise increase
the deductible to $30,000. There is a $7500 (increased to $10,000 for
accidents on or after October 1, 2003) deductible applicable to
family members' claims for loss related to the injury of their relative.
Once again, this deductible is money from the assessed loss for pain and
suffering which the insurer of the at-fault driver does not have to pay. The threshold was reinforced
with the 2003 amendments to require the injury not only to
be serious and permanent but to have a drastic effect on a claimant's ability to
work or perform their normal day to day activities.
To make a claim against the at-fault driver's insurer under the present system,
without serious and permanent injury, you need only have financial loss of an
income above $500 net per week. A person who has lost that income would
receive $400 per week from their own insurer and claim the amount above that
from the other driver's insurer.
There is a requirement to give notice of the claim within 120 days of the
accident date and then to provide substantial disclosure of medical records and
other documents. The notice requirement does have exceptions but you should see
a lawyer for advice and possibly to have a notice letter sent within the first
four months after the accident once you have some indication of the
extent of your problems or financial losses. The time limit of two years
to sue from the date of
accident continues to apply but for children it is two years from their 18th
birthday. |