I was At-Fault for a Car Accident but Injured, What Benefits Do I Qualify For?

Being involved in a motor vehicle accident is distressing, but when you’re at fault and injured, the situation can feel utterly overwhelming. You might wonder what benefits you’re entitled to and whether your own mistakes might leave you without the support you need. 

The good news is that Ontario’s no-fault insurance system provides statutory accident benefits coverage to all injured persons, regardless of fault. However, understanding what you qualify for and how to secure those benefits can be a complex process. This guide will walk you through the essentials, offering clarity and confidence in a time when you may feel unsure about your next steps.

Let’s start with a simple fact: in Ontario, fault doesn’t determine your right to accident benefits. The province operates under a no-fault insurance system, meaning that if you’re injured in a car accident, you can apply for certain benefits through your own auto insurance policy, regardless of who caused the crash. So, you don’t have to worry that being at fault could leave you stranded without help. However, it’s essential to know what’s available to you and how to make the most of these statutory accident benefits coverages.

Now, let’s break down the types of benefits you might be entitled to, even if you were at fault in the accident.

Medical and Rehabilitation Benefits

Injuries can range from minor to life-altering, and medical and rehabilitation expenses can quickly add up. Statutory accident benefits coverages are there to help cover these costs, from hospital visits, surgeries, and medications, to physiotherapy, chiropractic care, and even psychological counselling.

You’ll need to submit detailed treatment plans, often developed in consultation with your healthcare providers, to your insurance company. It’s a process that requires thorough documentation and sometimes a bit of negotiation to ensure you’re receiving the full extent of benefits you’re entitled to.

Income Replacement Benefit

If your injuries prevent you from working, an income replacement benefit can be a lifeline. This benefit typically covers 70% of your gross weekly income, up to a maximum of $400 per week, unless you have purchased optional benefits, allowing you to maintain some financial stability while you recover.

Of course, the process to claim these benefits involves demonstrating the extent of your injuries and how they directly impact your ability to earn. Medical reports and employer statements play a key role in this, ensuring that your insurer understands the severity of your situation and that they pay income replacement benefits accordingly.

Caregiver Benefits

Caregiver benefits are optional benefits that must have been purchased prior to an accident. These are available if you were responsible for caring for a loved one and your injuries now prevent you from fulfilling that role. Whether it’s looking after children, an elderly parent, or a dependent with special needs, these benefits can help cover the cost of hiring someone to take over those responsibilities.

Non-Earner Benefits

What if you’re not employed at the time of the accident, but your injuries still leave you unable to lead a normal life? That’s where non-earner benefits come in. These are specifically for individuals who don’t qualify for income replacement benefits, such as students, retirees, or homemakers. If your injuries significantly impact your ability to engage in regular activities, non-earner benefits provide some financial relief.

Attendant Care Benefits

Sometimes, injuries are so severe that the injured person needs assistance with daily living activities—bathing, dressing, or even moving around your home. Attendant care benefits are meant to cover the cost of hiring help, like a personal support worker or nurse, to provide this assistance. This is particularly important for those who suffer from serious, life-altering injuries that demand long-term care.

Knowing what benefits you’re entitled to is one thing; securing them is another. The process starts with notifying your insurance company as soon as possible after the accident. Prompt reporting is critical because there are specific timelines you must follow to maintain your eligibility for benefits.

Once you’ve reported the accident, you’ll need to complete various forms, including a detailed account of the accident, descriptions of your injuries, and any medical treatment you’ve received so far. Your insurance company may require additional documentation, such as medical reports or income statements, depending on the benefits you’re applying for.

It’s not unusual for the accident benefits claim process to involve back-and-forth communication with your insurer. They might ask for further information or clarification; patience and persistence are key here—having all your paperwork in order and responding promptly to requests can help speed up the process.

Even with the no-fault system in place, obtaining accident benefits can sometimes be an uphill battle. Insurance companies might deny claims, argue that your injuries aren’t as severe as you claim, or offer benefits that don’t fully meet your needs. Facing these challenges without the guidance of an experienced personal injury lawyer can be immensely challenging, often leaving injured individuals feeling isolated and frustrated.

At DWA Law, we specialize in motor vehicle accidents and personal injury cases, and we also understand the complexities surrounding life and critical illness insurance claims. When you’re at fault and injured, that doesn’t mean you should go without support. This is where having a personal injury lawyer from our team on your side can make all the difference.

Our car accident lawyers understand the intricacies of the insurance system and can advocate on your behalf to ensure you receive the benefits you deserve. They know how to gather the necessary evidence, negotiate with insurance adjusters, and if needed, represent you in court to secure a fair outcome.

We understand that every case is unique, and we’re committed to providing personalized legal support that addresses your specific circumstances. Reach out to DWA Law today to learn more about how we can assist you.