ACCIDENT BENEFITS IN ONTARIO
A BRIEF OVERVIEW
This is the sixth post in a series called “Accident Benefits in Ontario – A Brief Overview”. In these posts we talk about different aspects of Ontario’s Accident Benefits insurance coverage, also referred to as the no-fault insurance. Almost all of the content discussed in these blogs deal with the law as it applies to accidents that happened on or after September 1, 2010. Please contact us if your accident took place before September 1, 2010 and you would like to apply to accident benefits.
Am I eligible for non earner benefits?
This benefit is payable if the insured sustains a “complete inability” as a result of the impairments sustained in the accident. “Complete inability” means that the impairment continuously prevents the person from engaging in substantially all of the activities in which he or she ordinarily engaged in before the accident.
What is Complete Inability?
This is an onerous test for the victims of car accidents to meet. It requires an examination of the activities the person engaged in before the car crash and a comparison to his or her life circumstances after the car crash. To understand the applicant’s lifestyle before the accident, different aspects of his or her life would be considered. The focus will be on the most significant aspects of one’s life, such as employment, parental role, etc. However, a great degree of weight will be assigned to those activities, which were important to the applicant. To qualify the person must establish that they have significant degree of impairment that imposed a marked and measurable impact on the levels of their functioning and their ability to continue their pre-accident activities.
What is meant by “Continuously Prevents”, in the test for Non earner benefits?
The Ontario Court of Appeal, in the seminal decision of Heather v. Economical Mutual Insurance Co.,  O.J. No. 1877, 2009 ONCA 391 (Ont. C.A.) explained that the phrase “continuously prevents” means that an applicant must prove “disability or incapacity of the requisite nature, extent or degree which is and remains uninterrupted”. However, absolutely continuous disability is not required. Yet, a brief period of disability will certainly not be sufficient to meet the test.
Can I receive Income Replacement or Caregiver Benefit as well as non-earner benefits?
Note that the injured person is not eligible for non-earners benefits if he or she qualifies for and receives income replacement benefits or caregiver benefits.
Non-earner benefits for Students or Recent Graduates:
Non-Earners Benefit is also available for those who meet the complete inability test and were a full time student enrolled in elementary, secondary, or post-secondary school. It is also available to those who completed their education less than a year prior to the accident and were not employed or self-employed in a capacity that reflected their education. To complete one’s education, doesn’t mean that there is no plan to continue. Completion of a specific stage of education, such as high school, allows one to meet the requirements.
How much is payable under Non-Earners Benefit?
The amount payable under non earner benefits is $185/week or about $740 month and it is only payable only for two years. No non-earners benefit is payable for the first four weeks after the car accident.
The amount and duration of benefits changed on June 1, 2016. For those whose car accident happened prior to June 1, 2016 this benefit was payable for an indefinite period of time but they had to wait 26 weeks or 6.5 months from the commencement of their complete inability before receiving any payments.
Prior to the June 1, 2016 changes to the Statutory Accident Benefits Schedule (SABS), the amount of non-earner benefit would increase from $185/week to $320/week or $1,280/month, after two years, if the person was enrolled in elementary, secondary, or post-secondary education at the time of the accident. The June 1, 2016 changes eliminated this increase.
Non-Earners Benefit is Only Available if you are 18+
In addition, NEB used to be payable to anyone over the age of 16 but the June 1, 2016 changes increased that to the age of 18.
Bear in mind that the test for NEB requires continuous disability. Therefore, if the claimant suffered a complete inability before turning 16 but his or her condition improved gradually such that upon turning 16 she was able to engage in most of her pre-accident activities she will likely not qualify to receive NEB.
Along with a number of other cuts to accident benefits, non earner benefitss was significantly effected with the changes the government introduced, which became effective on June 1, 2016. For a discussion on those changes, please see our June 5, 2016 blog by clicking here. However, the test for entitlement to non earner benefit remains the same. The duration that one can receive this benefit is limited to two years, for those who were involved in car accidents on or after June 1, 2016. Moreover, this accident benefit is no longer available to those who are under 18.
If you believe that you may be entitled to non-earners benefits or any other accident benefits do not hesitate to call us. We will be glad to answer any questions you may have.
Toll-Free: 1(800) 945-8053