The 3 Most Important Changes to the Ontario Statutory Accident Benefits Schedule From the Perspective of Hospital Trauma Workers

Author(s): Darcy R. Merkur, Leonard H. Kunka, Stephen M. Birman

October 21, 2010

Anyone injured in a car accident is entitled to accident benefits (also known as no-fault benefits).  The Statutory Accident Benefits Schedule (the “SABS”) sets out a person’s benefit entitlement and the process to access those benefits.

Several significant changes have been made to the SABS effective September 1, 2010.  These changes may have an impact on how hospitals and hospital trauma workers effectively assist injured motorists.

From the perspective of a hospital trauma worker, we highlight the following three changes.

1.         Benefit Reductions:

Several SABS benefits have either been eliminated or substantially reduced. These include the following benefit reductions in non-catastrophic cases:

  • Medical and Rehabilitation benefits have been reduced to $50,000.00 (from $100,000.00)
  • Attendant Care benefits have been reduced to $36,000 (from $72,000)
  • Housekeeping and Home-Maintenance benefits of $100 per week have been eliminated
  • Caregiver benefits are no longer available (i.e. normally for stay at home parents).

Hospital Impact: As a result of these reductions patients may be interested in extending their hospital stay—since the benefits will be inadequate to pay for their needed care and treatment at home.

2.         Incurred Expenses:

A new definition of “incurred” is used throughout the SABS, restricting compensation to family members for time spent providing needed care to loved ones following a motor vehicle accident.  The new definition of “incurred” requires non-professional service providers (like a family member) to sustain an economic loss in order to provide the service (i.e. forego income to care for a loved one).

Hospital Impact: As a result of this new definition, insurance adjusters may be more interested than ever in taking statements from patients while in hospital to try to pin down information about care providers.

3.         Treatment and Assessment Plans – Deadlines and Emergency Services:

The deadline for insurers to respond to treatment and assessment plans has been increased to 10 business days (from 3 business day for assessment/examination applications).

But note section 38(2) of the SABS contains limited important exceptions to this rule in cases where:

  • the expense is for an ambulance or other goods or services provided on an emergency basis not more than five business days after the accident to which the application relates; or,
  • the expense is reasonable and necessary as a result of the impairment sustained by the insured person for,
    1. drugs prescribed by a regulated health professional, or,
    2. goods with a cost of $250 or less per item.

Hospital Impact: Hospital trauma workers can act quickly to arrange emergency goods or services within 5 business days of an accident to ensure that the insurer will pay for the goods or services without delay.

Presented at St. Michael’s Hospital on October 21, 2010

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