Protecting yourself with optional insurance benefits

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When it comes to auto insurance, there is no such thing as having too much.

The premium for your automobile insurance policy includes coverage for “no-fault”   accident insurance benefits -- more formally known as Statutory Accident Benefits. All car owners must carry insurance, and all such insurance includes accident benefits.  If you have been injured, then irrespective of who is at fault, your own insurance company must provide you with accident benefits under the Statutory Accident Benefits Schedule (“SABS”) enacted pursuant to the Insurance Act.

Your standard accident benefits package includes coverage for the following:

•    Weekly income replacement benefits, if you are unable to work following your accident.  

Maximum: 70% of your gross income, up to a maximum of $400 per week.

•    Medical and Rehabilitation benefits, which includes funding for medications, dental services, transportation to and from medical appointments, physiotherapy, psychological therapy, massage therapy, occupational therapy, assistive devices, and vocational re-training.

Maximum: $50,000 over a 10-year period, subject to the insurance company’s right to challenge the expense submitted

•    Attendant care, such as private nursing care or supervision.

Maximum: $3,000 per month for 2 years, so long as the person providing the attendant care has either been hired to do so, or incurs an economic loss while providing attendant care (i.e. a family member takes time off work to take care of you).

For the average person, the above limits are sufficient.  But we purchase insurance to protect us against “un-average” incidents.  In my practice, I see so many individuals who are severely injured, and require an enormous amount of medical, rehabilitative and supervisory attention after they are discharged from the hospital.  Broken limbs requiring surgery and wheelchairs, brain injuries that are categorized as “mild” but nonetheless have a devastating impact on a person’s functioning,  individuals who must spend part of their convalesence in a private nursing home but lack the money to pay for it...these are all scenario’s that will deplete the available insurance funds in a heartbeat.

As you know, OHIP has its limits.  Non-OHIP services are exorbitant. Many employment-sponsored benefits plans are capped at a yearly $300 limit.  

Many of my clients use up the $50,000 medical-rehabilitation limits within 6 months to a year, especially if they need various therapies for extended periods. If a young person is injured, the $50,000 will not last them for a lifetime.  Similarly, many individuals who are severely injured need attendant care well beyond the 2 years allowed under the legislation.

This is why I purchased Optional insurance benefits, and strongly recommend that you do so as well.

OPTIONAL COVERAGE

You can increase the above limits if you purchase Optional Coverage.  For a small additional premium, you can purchase enhanced protection for yourself and your family members.  Your insurance representative or broker has a duty to offer Optional Coverage to you.  

Weekly Income Replacement Benefits: The weekly cap can be increased from $400 to $600, $800 or $1000.

Medical and Rehabilitation Benefits: The 10-year maximum of $50,000 can be increased to a lifetime maximum of $1,000,000.

Attendant Care: The $3,000 monthly maximum payable for two years can be increased to a monthly $6,000 maximum payable for lifetime.

Housekeeping: Currently only available for Catastrophic injuries, optional coverage can be obtained which will pay $100 per week for two years.

Your premium also covers accident benefits for “minor injuries”, which are defined in the SABS as a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any “clinically associated sequelae”.

If you have a “minor injury”, your medical-rehabilitation expense limits are only $3,500, and attendant care is not available.  Unfortunately, optional enhanced coverage has no application to individuals with minor injuries.

Najma M. Rashid is a lawyer and partner at Howard Yegendorf & Associates and its sister firm, BrazeauSeller.LLP.  She practices in the areas of personal injury and insurance. For more about Najma and her practice, please visit www.YegendorfLawFirm.ca or www.brazeauseller.com.  Najma can be reached at nrashid@YegendorfLawFirm.ca and (613) 237-5000 ext 243.

For information on placing a sponsored article on OBJ.ca, please contact Terry Tyo at 613-238-1818, ext. 268.

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