A traumatic brain injury (TBI) can be one of the most life-altering consequences of a car accident. Even a mild concussion can lead to long-lasting symptoms such as memory loss, cognitive impairments, headaches, emotional instability, and more. If you or a loved one has sustained a brain injury in a motor vehicle accident in Ontario, it’s important to understand your rights under the Statutory Accident Benefits Schedule (SABS).
In this article, we break down the essentials of accessing accident benefits for brain injuries in Ontario, what you may be entitled to, and how a brain injury lawyer can help protect your claim.
What Are Accident Benefits in Ontario?
Accident benefits are part of Ontario’s no-fault auto insurance system. Regardless of who was at fault for the accident, individuals injured in a car crash are entitled to certain benefits through their own insurance provider. These benefits are governed by the Statutory Accident Benefits Schedule (SABS) under the Insurance Act.
Why Brain Injuries Are Treated Seriously
Brain injuries can be complex and unpredictable. Symptoms may not be immediately obvious and can worsen over time. This is why it’s critical to seek medical attention right away, even if you believe the injury is minor.
Under Ontario’s accident benefits system, brain injuries are often classified as catastrophic impairments, particularly if they result in long-term or severe cognitive and physical limitations. This designation can significantly increase the amount and duration of benefits available.
Key Benefits Available for Brain Injury Victims
If you’ve suffered a brain injury in a car accident, you may be entitled to several types of benefits, including:
1. Medical and Rehabilitation Benefits
Covers costs for treatments such as:
- Neurological assessments
- Cognitive therapy
- Physiotherapy
- Medications
- Psychological counseling
Non-catastrophic injuries are eligible for up to $65,000 in combined medical and attendant care benefits, while catastrophic injuries may access up to $1,000,000.
2. Attendant Care Benefits
If you require assistance with daily living tasks (e.g., bathing, eating, dressing), this benefit helps pay for a personal support worker or caregiver.
3. Income Replacement Benefits
If you can’t return to work due to your brain injury, you may receive up to 70% of your gross income, to a maximum of $400 per week, unless optional higher coverage was purchased.
4. Caregiver, Housekeeping & Home Maintenance Benefits
For those with catastrophic impairments, additional benefits may include:
- Compensation for a caregiver who helps with dependent family members.
- Housekeeping support if you’re no longer able to manage basic home tasks.
When Is a Brain Injury Considered “Catastrophic”?
A brain injury may be deemed catastrophic if it results in:
- A Glasgow Coma Scale (GCS) score of 9 or less.
- Severe, long-term impairment in cognitive functioning.
- Diagnosed mental or behavioural disorders that severely limit daily activities.
A catastrophic impairment determination can significantly affect the level of benefits you’re eligible for. A qualified medical team, and often a legal advocate, are essential in supporting this classification.
How to Apply for Accident Benefits
- Notify your insurance provider within 7 days of the accident.
- Complete the Application for Accident Benefits (OCF-1) as soon as possible.
- Submit all supporting medical documentation, including imaging results, assessments, and physician reports.
- Consult a personal injury lawyer to ensure you’re applying for all available benefits and that your injury is properly classified.
Why You Should Speak With a Personal Injury Lawyer
Brain injuries often lead to complex and drawn-out recovery journeys. Unfortunately, insurance companies may dispute the severity of your injury or delay benefit payments. A personal injury lawyer who understands Ontario’s accident benefits system can:
- Ensure all paperwork is properly completed and submitted.
- Help you pursue a catastrophic designation if applicable.
- Negotiate with the insurer on your behalf.
- Guide you through appeals if benefits are denied.
Final Thoughts
Living with a brain injury is never easy but you don’t have to navigate the recovery process alone. Ontario’s accident benefits system offers vital financial and medical support to help you heal. If you’ve been injured in a car accident in Toronto or elsewhere in Ontario, speak with a legal professional as soon as possible to protect your rights and secure the benefits you deserve.