If you were injured in a motor vehicle accident, you might need treatment. SAB benefits may help you with some of your costs. This blog will explain what SAB benefits are, how a SAB claim is made, which injuries entitle you to benefits and what those benefits are.
What Are SABS? Statutory Accident Benefits or SABs are benefits set by the Ontario legislature that are available to insured people following a motor vehicle accident. Think of them as the minimum benefits an insurance company can provide to clients who suffered injuries due to a motor vehicle accident. (The benefits outlined in this blog only apply to those with standard insurance plans. With additional insurance, the insurance company is required to provide whatever additional coverage you have. Still, this additional coverage cannot provide less than what is outlined here.) How Do I Get SAB If My Insurance Company Is Not Cooperating? There is an appeal process if your SAB benefits are denied. Your claim goes before the “License Appeal Tribunal” (The LAT). This operates like a court. Your treatment plans are submitted to an adjudicator, which is the LAT’s version of a judge. Both sides make arguments before the adjudicator. Your lawyers argue that your treatment plans are necessary. Your insurance company tries to argue the opposite. The adjudicator will approve or deny each plan individually. The LAT will not usually approve treatment plans that last longer than 6 months. As a result, we generally submit 6-month treatment plans. We submit new treatment plans when a treatment plan runs out. We repeat this process until the benefits run out or the matter settles. (For more information on the LAT click here) How Much Treatment Do SABS Cover? (For a more detailed breakdown of which injuries entitle you to receive certain SAB benefits, follow this link) This depends on the category of your injuries. The categories are “Minor,” “Non-Catastrophic” and “Catastrophic” impairment. These categories can be more inclusive than they sound. Minor Injuries The Minor Injuries Guidelines (the “MIG”) set the rules for minor injury benefits. The MIG defines minor injuries as: “a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae. This term is to be interpreted to apply where a person sustains any one or more of these injuries.” A rule thumb is: “Your injuries are minor if you can expect to make a full recovery in a reasonable amount of time.” For more details on the MIG, check out this previous blog. For minor injuries, your SAB benefits are a maximum of 3,500 dollars worth of (LAT approved) medical treatment for up to 5 years following the accident. With all injuries, you are entitled to income replacement benefits (IRBs). You are entitled to 70 percent of your weekly income to a maximum of 400 dollars a week. If you were unemployed before the accident, you are entitled to 185 dollars a week for 2 years post-accident. Non-Catastrophic Impairment Non-Catastrophic Impairment is defined by what is not. Think of them like goldilocks from the children’s story. Non-Catastrophic Impairment exists in the middle of two extremes. The impairment must be too severe to fall under the MIG but not severe enough to qualify for catastrophic impairment benefits. For non-catastrophic impairment, insurance companies must cover up to 65,000 dollars of (LAT approved) treatment plans for up to 5 years post-accident. Catastrophic Impairment Benefits for catastrophic impairment claims are the best. The insurance company must cover up to 1 million dollars worth of treatment for your lifetime, up to 100 dollars a week in housekeeping/home maintenance over your lifetime and up to 250 dollars a week in childcare (plus 50 dollars for each additional child). Keep in mind that these numbers do not represent money that goes into your pocket. They represent the maximum amount of treatment/housekeeping/childcare that the LAT could award. Routes to Qualify **WARNING***: (Do not be fooled by the word “catastrophic”; often, people who suffer from CAT impairment would not describe their injuries as catastrophic.) There are six different routes for your injuries to qualify for catastrophic (CAT) impairment benefits: > The first route is to show that you are paraplegic or tetraplegic. This means if you are paralyzed from the waist down or the neck down. This is evaluated by the ASIA impairment scale. > The second route is to show major loss of use in an arm or an injury that has severely impaired your ability to walk. To qualify with an arm injury, you must show a permanent and total loss of use. You must show your arm is as useful as the missing arm of an amputee. Injuries to your legs/ability to walk are evaluated using the Spinal Cord Independence Measure. > The third route is to show loss of vision. You must show the MVA reduced your visual acuity to 20/200 or less, or show that the MVA reduced the greater diameter of your visual field to 20 degrees or less. Visual acuity is measured by a Snellen or equivalent chart. > The fourth route is to show traumatic head injury. There are a couple of ways you can qualify through this route. The first is to have positive imaging of a brain injury. This means if your injury can be picked up on an MRI or CAT scan, you qualify for catastrophic impairment benefits. The other way to qualify for CAT benefits through head injury is to show the trauma altered your mental functioning. You must show the MVA either:
put you in a vegetative mental state for a month or longer;
gave you an upper severe disability for 6 months or longer;
or gave you a lower moderate disability for a year or longer.
> These time frames differ if you were younger than 18 when the accident happened. > The fifth route is through whole body impairment. In order to qualify for this benefit, your injuries must be assessed at 55 percent total body impairment. This is assessed through the American Medical Association’s Guide to Permanent Impairment. (For more information on this, click the link to this blog). > The sixth and final route is to show mental and behavioural impairment. This is also assessed through AMA’s Guide to permanent impairment. The guide sets out four spheres of mental functioning. To qualify for CAT benefits, you must show a class 4 impairment in at least 3 spheres, or a class 5 impairment in at least one sphere. (For more information on this, click the link to this blog). Contact Us If you have a SAB claim, you do not want to go through this alone. Contact Littlejohn Barristers at 705-725-7255. We are a leading law firm in Barrie for Motor Vehicle Accident claims. We would love to hear from you.