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INJURED?<br />

<strong>In</strong> a <strong>Motor</strong> <strong>Vehicle</strong> Accident?<br />

This booklet provides information<br />

about insurance benefits and other<br />

compensation available to you when you<br />

are injured in a motor vehicle accident<br />

in Ontario.


For immediate assistance call<br />

1.855.1234 TODAY!<br />

This booklet is for informational<br />

purposes only and is not intended<br />

to be a substitute for legal advice


Table of contents<br />

Am I entitled to benefits after a car accident?..................4<br />

Why are accident benefits important?......................................5<br />

Receipts .........................................................................................................4<br />

When and how do I obtain accident benefits?...................6<br />

Categories of injuries .........................................................................8<br />

What happens next? ............................................................................10<br />

Other insurance benefits/private health plans................11<br />

Do I have the right to sue at-fault persons?......................12<br />

Choosing a personal injury lawyer ..........................................13<br />

10 Questions To Ask Your Personal <strong>In</strong>jury Lawyer..........14<br />

What help can I get in the hospital?.......................................15<br />

your reference/contacts list.......................................................16<br />

Key facts/details of accident.......................................................17<br />

What to do AFTER an Accident Checklist...........................18<br />

p.a.c.e. centre contact info............................................................19


What you should know when<br />

you are injured in a motor vehicle<br />

accident...<br />

Q.<br />

Am I entitled to benefits after a car accident?<br />

A. YES. <strong>In</strong> the province of Ontario, there are two sources of<br />

compensation available:<br />

1. An Accident Benefit Claim:<br />

A claim against your own insurance company or the car<br />

insurance company of another vehicle involved in the accident.<br />

2. A Tort Claim:<br />

A lawsuit against the at-fault driver.<br />

What is “Accident Benefit”?<br />

If you or a loved one has been<br />

injured in a motor vehicle accident<br />

and has sustained physical and/or<br />

psychological injuries, you are<br />

entitled to “Accident Benefits.”<br />

These benefits are available to:<br />

drivers<br />

passengers<br />

pedestrians hit by a motor<br />

vehicle or other insurable<br />

vehicle<br />

cyclists hit by a motor<br />

vehicle or other insurable<br />

vehicle<br />

Even if the accident was your fault, you<br />

are still entitled to receive accident benefits.<br />

Even if you do not have your own<br />

motor vehicle insurance, you are entitled<br />

to receive accident benefits.<br />

- PAGE 4 -<br />

IMPORTANT!<br />

Receipts:<br />

Keep all of your receipts related<br />

to your treatments. The receipts<br />

help to prove to the insurance<br />

company what accident-related<br />

expenses you or your family has<br />

paid.


What is the purpose of<br />

accident benefits?<br />

Accident benefits have been put in place by the government to help you<br />

recover from your accident-related injuries. There are various benefits<br />

available to you while you are on the road to recovery. Some of the<br />

following benefits may be available to you depending upon your motor<br />

vehicle insurance coverage and your eligibility.<br />

possible Types of benefits:<br />

Medical and Rehabilitation<br />

Benefits<br />

Attendant Care<br />

Benefits<br />

<strong>In</strong>come Replacement<br />

Benefits<br />

Caregiver<br />

Benefits<br />

Visitation Expenses<br />

Housekeeping/Home<br />

Maintenance Expenses<br />

Additional benefits may<br />

include:<br />

Services of a Case<br />

Manager<br />

Loss of Education Expenses<br />

Non-Earner Benefits<br />

Dependent Care Benefits<br />

Damage to Clothing Expenses<br />

Death & Funeral Benefits in<br />

cases of death.<br />

Pays for your medical treatment, therapy,<br />

medication and required equipment, housing<br />

and transportation.<br />

Pays for “hands on” care during your recovery.<br />

Pays for a portion of income lost resulting from<br />

not being able to return to work due to injuries<br />

sustained. The amount of coverage is limited or<br />

a “capped benefit”.<br />

Pays for costs associated for childcare if you are<br />

unable to care for your children or other<br />

dependents. Coverage is limited/capped benefit.<br />

Reimburses immediate family members for<br />

visitation expenses including travel, parking,<br />

meals and accommodations.<br />

Assists with costs because of your inability to<br />

do your present and future housekeeping and<br />

maintenance chores.<br />

Pays for a rehabilitation coordinator to help<br />

assist with your recovery. (This benefit is only<br />

available in “catastrophic impairment” cases,<br />

see page 8).<br />

- PAGE 5 -


When and how<br />

do I obtain accident benefits?<br />

Within 7 days of the motor vehicle<br />

accident, you must call your motor<br />

vehicle insurer stating that you want<br />

to apply for accident benefits.<br />

The sooner you call the better.<br />

You may need therapy, equipment,<br />

assistive devices, or other medical<br />

services when you leave the<br />

hospital. If you call the insurer early,<br />

benefits can be coordinated so that<br />

you will have what you need when<br />

you get home.<br />

Either you or someone close to you should call the first insurer that applies to<br />

you based on the order of the list below (top down):<br />

1. insurer of your motor vehicle<br />

2. insurer of the motor vehicle under which you are insured<br />

3. the insurer of the motor vehicle in which you were an occupant<br />

4. insurer of the motor vehicle that struck you if you were a<br />

pedestrian or cyclist<br />

5. insurer of any other motor vehicle involved in the accident<br />

6. the <strong>Motor</strong> <strong>Vehicle</strong> Accident Claims Fund<br />

(in Canada, call 1-800-268-7188)<br />

When you call the insurer, tell them that<br />

you want to start an accident benefits claim.<br />

The insurer will ask you for some basic<br />

information including the following:<br />

name and age of the injured person<br />

the nature of the injuries<br />

your insurance policy number<br />

motor vehicle information<br />

basic details about the accident<br />

Some people may wish to consult a personal injury lawyer<br />

to advise them about their claim.<br />

- PAGE 6 -


IF YOU DON’T CALL...<br />

If you do not call the insurer within 7 days, the<br />

insurer has the right to delay providing you with<br />

benefits.<br />

An application for accident benefits will need to<br />

be completed. A copy of the application can be<br />

obtained from your social worker at the hospital,<br />

the insurance company or a personal injury<br />

lawyer.<br />

online list of<br />

auto insurance<br />

companies in<br />

canada:<br />

https://en.wikipedia.org/<br />

wiki/List_of_Canadian_<br />

insurance_companies<br />

Upon receipt of your<br />

completed Application...<br />

Upon receipt of your completed<br />

Application for Accident Benefits<br />

(OCF-1), your insurer will review your<br />

application and ask you to have a<br />

Disability Certificate completed by a<br />

health practitioner of your choice.<br />

Essentially, this form states the cause<br />

and nature of your impairment(s) and<br />

the estimated duration of your disability.<br />

- PAGE 7 -


what are the Levels of Benefits?<br />

There are 3 Levels of Benefits Based on Your <strong>In</strong>jury Classification which are<br />

based on your injuries, you are either classified as:<br />

1) Minor <strong>In</strong>jury Guideline (MIG)<br />

2) Non-Catastrophic <strong>In</strong>jury<br />

3) Catastrophic <strong>In</strong>jury<br />

How do insurance companies<br />

categorize different injuries?<br />

The following injuries will be classified as minor and will be treated<br />

within the Minor <strong>In</strong>jury Guideline (MIG):<br />

Sprain - means an injury to one or more tendons or ligaments,<br />

including a partial tear<br />

Strain – means an injury to one or more muscles, including<br />

a partial tear<br />

Whiplash<br />

Contusion<br />

Abrasion<br />

Subluxation – means a partial dislocation of a joint<br />

If your injury falls within this category, the maximum Medical/Rehabilitation<br />

Benefits payable are $3,500.00<br />

You can still qualify for either<br />

the <strong>In</strong>come Replacement Benefit or<br />

the Non-Earner Benefit if your<br />

injury is minor; however you<br />

will not be eligible to receive<br />

Attendant Care Benefits.<br />

- PAGE 8 -


If your injury is classified as a Non-Catastrophic <strong>In</strong>jury, that is,<br />

an injury falling neither under the MIG, nor under the<br />

“catastrophic” classification, then you can receive up to $65,000.00<br />

in Medical/Rehabilitation and Attendant Care Benefits in addition<br />

to any <strong>In</strong>come Replacement or Non-Earner Benefit.<br />

If you sustain a Catastrophic <strong>In</strong>jury, you can receive up to<br />

$1,000,000.00 in Medical/Rehabilitation and Attendant Care Benefits.<br />

As well, <strong>In</strong>come Replacement Benefits are available. You will<br />

be deemed to have sustained a Catastrophic <strong>In</strong>jury if you have<br />

sustained any of the following injuries: Paraplegia<br />

Tetraplegia<br />

Severe impairment of<br />

ambulatory mobility or use<br />

of an arm, or amputation<br />

Loss of vision of both eyes<br />

Traumatic brain impairment<br />

Certain types of<br />

marked impairment or<br />

severe impairment<br />

- PAGE 9 -


What happens next?<br />

The insurance company will assign an<br />

accident benefits adjuster to your file<br />

whose focus will be on your injuries and<br />

health care needs.<br />

A separate adjuster will be assigned to<br />

deal with motor vehicle damages, if<br />

appropriate. The adjuster will advise<br />

you regarding the application package<br />

and required information. If you decide<br />

to retain a personal injury lawyer, his or<br />

her office will deal directly with the<br />

adjuster and can assist you in<br />

completing the application.<br />

Within 30 days of getting an application for Accident Benefits, you must<br />

send the completed application to the accident benefit insurer. If the form<br />

is not filled out and sent in, you will not get any compensation. You<br />

may not get certain benefits like attendant care benefits before the date<br />

you submit the application.<br />

The application for accident benefits will include a disability certificate.<br />

Wherever possible, give the insurer an accident benefit application and a<br />

completed disability certificate as soon as possible in order that benefits can<br />

start being paid.<br />

IMPORTANT!<br />

Return your completed<br />

Accident Benefit application<br />

within 30 days<br />

of receiving it or you<br />

will not get any<br />

compensation.<br />

AND, attendant care<br />

benefits may not start<br />

before the date you<br />

submit your completed<br />

application. - PAGE 10 -


Other insurance benefits/private<br />

health plans<br />

You should apply for Accident Benefits even if you<br />

have a health plan that may cover some of your<br />

medical expenses and/or income loss.<br />

Private health plans are often more limited than<br />

Accident Benefits in the types of coverage and<br />

amounts available to be paid.<br />

IMPORTANT!<br />

If you are eligible for<br />

medical or disability<br />

benefits through a<br />

private or work-related<br />

health plan, that health<br />

plan will be the first<br />

insurance company<br />

in line to pay for<br />

certain expenses<br />

before the Accident<br />

Benefits insurer.<br />

However, you should apply to both insurance<br />

companies to get coverage for all your needs.<br />

- PAGE 11 -


what’s a tort claim...<br />

Q.<br />

A.<br />

Do I have the right to sue at-fault persons?<br />

YES. A claim against the at-fault driver is called a tort claim.<br />

This claim is usually paid by the auto insurance company of the<br />

at-fault driver. Tort law allows an injured person to obtain compensation<br />

from the person who caused the injury. More than 95% of these claims<br />

are settled before they go to trial.<br />

A personal injury lawyer can give you information about your rights and<br />

those of your family to obtain compensation from anyone potentially responsible<br />

for the accident. These claims are over and above any<br />

accident benefits you may be entitled to receive.<br />

<strong>In</strong> a claim, family members may recover income they have lost while<br />

caring for you, as well as other out-of-pocket expenses that have not<br />

otherwise been reimbursed.<br />

<strong>In</strong> some cases claims against at-fault persons will include claims for:<br />

future income loss or loss of opportunity that you suffer as a<br />

result of your injuries and<br />

future medical and rehabilitation expenses.<br />

pain and suffering<br />

<strong>In</strong> almost all cases you only have two years from the date of a motor<br />

vehicle accident to start a lawsuit. A personal injury lawyer can<br />

provide information about the deadlines that apply in your case.<br />

More than 95%<br />

of these claims<br />

are settled<br />

before they go<br />

to trial.<br />

- PAGE 12 -


Choosing a personal injury lawyer...<br />

helpful numbers...<br />

You may call the<br />

Patient Ambulatory Care<br />

Education Centre and be<br />

referred to a lawyer within<br />

your community with the<br />

appropriate expertise for:<br />

a FREE consultation<br />

a FREE document review<br />

a FREE second opinion.<br />

CONTACT US TODAY!<br />

1-855-123-4567<br />

or 416-947-3330<br />

You or your family member may wish to consult<br />

a personal injury lawyer following a serious<br />

personal injury. Finding the right lawyer to<br />

represent both your current and your future<br />

needs is an important decision, especially if your<br />

injuries are permanent or you need long term<br />

rehabilitation. Seeking compensation and<br />

applying for Accident Benefits is a complicated<br />

process with specific time lines. The decisions<br />

that you are being asked to make are happening<br />

at a very difficult time in your life. It is important<br />

that you are fully aware of all your rights.<br />

We recommend you contact more than one law<br />

firm before making your final choice. You may<br />

call the Patient Ambulatory Care Education Centre<br />

and be referred to a lawyer within your community<br />

with the appropriate expertise for a FREE<br />

consultation, a FREE document review, or a FREE<br />

second opinion.<br />

Call 1-855-123-4567 or 416-947-3330 or<br />

(*)HURT or (#)HURT.<br />

- PAGE 13 -


10 Questions To Ask Your<br />

Personal <strong>In</strong>jury Lawyer...<br />

Here is a handy checklist of basic questions to ask before you<br />

retain a lawyer:<br />

1. Does the law firm specialize in personal injury?<br />

2. Will the law firm provide a FREE consultation?<br />

How quickly can they schedule your free no-obligation<br />

personal injury evaluation?<br />

3. Will the lawyer come to you at the hospital or in your<br />

home?<br />

Are visits available free of charge anywhere in Ontario?<br />

4. Does the firm bill on a contingency basis?<br />

(This means that no fees are collected by the lawyer<br />

until the matter is settled. The personal injury lawyer<br />

will receive a percentage of what you recover.)<br />

5. Have you handled matters like mine?<br />

What are the possible outcomes of my case?<br />

6. Approximately how long will it take to resolve my<br />

matter?<br />

7. How will you keep me informed of progress?<br />

8. Do you return calls in a short period of time?<br />

9. What kind of approach will you take to resolve the<br />

matter – aggressive and unyielding, or will you be<br />

more inclined to reach a reasonable settlement?<br />

10. Does the law firm have online reviews and testimonials for<br />

you to read?<br />

- PAGE 14 -


What help can I get in the<br />

hospital?<br />

Specialists at the Patient Ambulatory Care<br />

Education (P.A.C.E.) Centre are trained to help<br />

patients injured in motor vehicle accidents with<br />

insurance matters.<br />

Ask to see a specialist to help you fill out the forms<br />

and certificates that you need to make your claim.<br />

Call 1-855-123-4567 or 416-947-3330.<br />

Email: info@gtapace.ca<br />

- PAGE 15 -


your reference/contacts list<br />

Name:<br />

Phone Number:<br />

Emergency Contact:<br />

Ph:<br />

Family Doctor Name:<br />

Family Doctor Address:<br />

Hospital Address with Postal Code:<br />

Hospital Ph:<br />

Room Number:<br />

Hospital physician:<br />

Social worker:<br />

Patient navigator:<br />

Medications:<br />

Main <strong>In</strong>formation Desk:<br />

Patient Relations:<br />

Helpful Websites:<br />

- PAGE 16 -


Key facts/details of accident<br />

Background of Accident:<br />

Date of accident:<br />

Follow up<br />

with your<br />

insurance<br />

company<br />

within<br />

7 days to<br />

avoid delays<br />

in getting<br />

all the<br />

benefits you<br />

deserve.<br />

<strong>In</strong>jured person’s full name:<br />

<strong>In</strong>jured person’s date of birth:<br />

<strong>In</strong>surance information<br />

<strong>In</strong>surance company:<br />

<strong>In</strong>surance company’s telephone number:<br />

<strong>In</strong>surance policy number:<br />

Accident benefit adjuster:<br />

Accident benefit adjuster’s telephone number:<br />

Accident benefit claim number:<br />

Accident investigating details<br />

Location of accident:<br />

<strong>In</strong>vestigating Police Officer name:<br />

Police Officer’s badge number:<br />

Police Officer’s telephone number:<br />

Personal injury lawyer information<br />

Law firms name:<br />

Lawyer’s name:<br />

Lawyer’s telephone number:<br />

Protect what you are entitled to by filling out this form<br />

accurately.<br />

- PAGE 17 -<br />

Month<br />

Day<br />

Year


CHECKLIST:<br />

WHAT TO DO AFTER AN ACCIDENT<br />

Seek required medical attention.<br />

<strong>In</strong>form the police that you have<br />

been involved in a motor vehicle or<br />

boating accident.<br />

Record the insurance information<br />

of any vehicles involved in the<br />

accident.<br />

Record the names and addresses of<br />

all involved parties and witnesses<br />

to the accident.<br />

<strong>In</strong>form your family doctor of the<br />

injury and keep track of the<br />

physicians and health care<br />

professionals you have seen.<br />

Contact one of our personal injury<br />

lawyers to find out about your legal<br />

rights.<br />

Notify the accident benefits<br />

insurance company within 7 days<br />

of your automobile accident.<br />

Notify your employer or school of<br />

your accident and injury.<br />

<strong>In</strong>form your bank manager and<br />

credit card company about your<br />

accident.<br />

Keep receipts of all accident<br />

related expenses. Family members<br />

should also record the dates and<br />

time spent caring for the injured<br />

person.<br />

slips & falls:<br />

For slips and falls on sidewalks and<br />

roadways, immediately notify the<br />

municipality where the fall occurred<br />

about your claim. You should contact<br />

one of our lawyers to do this on your<br />

behalf.<br />

For private property slips and falls,<br />

for example in a mall, make sure<br />

that the injury is reported to the<br />

management office and a report<br />

taken.<br />

Ask for a copy of the incident report.<br />

Ask if there is a security camera that<br />

may have recorded the fall.<br />

Track all your medication, rehabilitation,<br />

and other expenses related to<br />

your accident.<br />

Record the names and contact<br />

information of individuals you have<br />

discussed your injury with.<br />

Check for other insurance<br />

coverage (i.e., through your work,<br />

school, or private plans).<br />

- PAGE 18 -


Patient Ambulatory Care Education (P. A. C. E.) Centre<br />

we are here to help<br />

PERSONAL INJURIES HURT!<br />

What should you do?<br />

Do you know your Legal Rights?<br />

Contact Us Anytime!<br />

We are here to help you through this....<br />

Patient Ambulatory Care Education (P. A. C. E.) Centre<br />

520 Ellesmere Road.<br />

Scarborough, ON<br />

Call: 1-855-123-4567 or 416-947-3330<br />

Email: info@gtapace.ca<br />

WE OFFER<br />

FREE 1 Hour Case Evaluation<br />

(which includes a Q&A period)<br />

WHAT IMMEDIATE Action Steps?<br />

(info one should take to build a winning case<br />

FAST)<br />

FREE Document Review<br />

FREE Second Opinion<br />

FREE Hospital & Home Visits<br />

Take the first step to get the best medical attention<br />

and settlement you deserve.<br />

- PAGE 19 -


Patient Ambulatory Care Education (P. A. C. E.) Centre<br />

520 Ellesmere Road.<br />

Scarborough, ON<br />

Call 1-855-123-4567 or 416-947-3330.<br />

info@gtapace.ca

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