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Retroactive Accident Benefits – Are They Available?

If you or someone dear to you was injured in a car, truck, ATV, snowmobile or motorcycle accident in Ontario, and an Application for Accident Benefits was not filed immediately with the insurance company: are retroactive benefits available?

In most cases, the answer is yes. All Ontarians are covered for accident benefits if they are injured or killed in a motor vehicle accident. This is true regardless of fault for the accident. Pedestrians, cyclists, and passengers are all eligible for benefits. Benefits are even payable for people who are hurt by a driver who flees the scene or who is driving without insurance. Benefits available include medical and rehabilitation benefits, income replacement benefits, attendant care benefits, and other related expenses such as hospital visitors’ expenses and damaged clothing.

The Application for Accident Benefits is the initial application form to be completed when requesting accident benefits after being involved in a motor vehicle accident. The Statutory Accident Benefits Schedule (SABS) sets out timelines to notify the insurer of their intention to apply for benefits within 7 days of an accident. After receiving the application forms from the insurer there is an additional timeline of 30 days in which to forward the completed and signed application form. However, completing forms are not always the first thing that comes to mind after a devastating accident.

So, what happens when the timelines above are not met? If the insurer was not notified within 7 days of the accident, it may be argued that the person was unaware of the regulated timelines for reporting the accident due to the injuries suffered and need to attend to the emergency situation. The insurer can utilize their own discretion considering all the circumstances whether to pay for retroactive accident benefits that the person and family may have incurred and be entitled.

Other circumstances where retroactive benefits may be applicable are situations relating to income replacement benefits or attendant care benefits, where the benefit(s) may be inappropriately “stayed” or “stopped” for a period of time while the insurer is gathering documentation. In situations like these, a knowledgeable and competent personal injury lawyer will be able to help navigate the complex insurance system and communicate effectively with the insurance company to ensure that your benefits remain intact.

In order to ensure that you or your loved one has access to all of the that you are entitled to under your insurance policy, and to ensure the strict timelines of the legislation are met, it is always best to seek the advice of an experienced personal injury lawyer, as soon as possible after the accident takes place.