Medical and Rehabilitation Expenses



As an injured person in Ontario, you will likely require health care services that are not covered by OHIP, such as physiotherapy, occupational therapy, chiropractic, massage, prescriptions, prolotherapy, psychology, vocational rehabilitation, dentistry and in catastrophic cases, additional services such as case management.

If you have extended health care benefits that cover all or some of these services, you will have to submit your expenses to that insurer first.

If you do not have extended health care or if there is a deductible (for example if they only pay 80%) or an annual limit for expenses that you exceed, or a particular service is not covered, you will have access to the medical and rehabilitation policy of the Accident Benefit insurer. Generally, you and the service provider make arrangements to have the AB insurance company pay the provider directly.

However, if there are accident-related services that are not covered, you or your lawyer will need to track those expenses to claim them from the at-fault driver. In addition, there is a policy limit for Accident Benefits depending on the severity of the accident (either $100,000 or $1,000,000). Any costs above what is covered by your accident benefit policy are claimable from the driver who caused the accident.

Loss of Income

Ontario accident victims are only entitled to 80% of their pre-trial loss of income. They are entitled to 100% of post-trial losses.

If you had a straight salaried position that you can no longer do, it will be relatively easy to calculate your past loss of income. However, you will want to be aware of any raises or bonuses your co-workers received if you would have received the same.

Calculating your loss of income is trickier when your pre-accident work was irregular, your career was on an upward trajectory or market conditions in your position were changing, for better or for worse. It is also more challenging to calculate income loss for people who are self-employed.

If you are retrained to work at another position, the income from your new position will have to be factored into your claim for losses.

It is very important to keep track of and document, as well as reasonably project any future or past income loss claim and related future loss of pension claim. We commonly use an economist, forensic accountant and / or an actuary to perform these types of calculations.

Other Types of Expenses

Out of pocket expenses for other services you are required to purchase because of your accident should also be tracked. For example, if you are unable to drive for four months because of a leg cast, you will have had transportation expenses. Records and receipts will be needed to prove those losses. If you were driven by a loved one, a record of that person's time will be important.

If you have to hire a babysitter to look after kids because you cannot take care of them due to your injuries or to get to medical appointments, and you did not qualify for the caregiver benefit under the Accident Benefits, you can claim these expenses from the at-fault driver if you have accurate records and can prove your losses.

An Important Note - Honesty is the Best Policy

No matter what, do not exaggerate your losses in terms of pain and suffering or in terms of out-of-pocket expenses. This is a way to kiss your case goodbye. You effectively play into the insurance company's premise that all claimants are fraudsters.

In our office, we repeatedly tell our clients that their number one job is to get better and to return, to the greatest extent possible, to their pre-accident condition. Which means you must admit when your injuries get better and the extent to which they get better. That means admitting that you had a good time on your family vacation that took place after the accident.

Will making this type of admission reduce your settlement or jury award? Yes, it may.

Unfortunately, your chances of a settlement or an award at trial decrease significantly if the insurance company produces a photo of you with a cocktail on the beach after you claim to have taken no vacations since the accident.

And speaking of honesty, it is also extremely harmful to your injury case to hide past accidents or past injuries. The truth is expose when you seek an accident settlement, regarless of whether or not you have a lawyer. A claimant who is not credible has very little bargaining power.

On the same note, if you are making an income loss claim, your past income tax returns will be relevant and will likely be produced. If your tax returns are not pristine, that can be a problem. Consider fixing any tax issues before embarking on settlement negotiations if possible. Use a reliable, credible professional for this purpose.