Terms | Definitions |
|---|---|
 What is a verbal threshold? | the words or language describing the nature and type of injury that must be suffered in order to sue. |
| What was the significant feature of the Ontario Motorist Protection Plan that made it different from earlier policies? | it removed the right to sue in all cases except when the injury exceeded a "verbal threshold". |
| How was the threshold defined under OMPP? | suit can only be brought if the injured person had a. died, b. permanent serious disfigurement c. permanent serious impairment of an important bodily function caused by continuing injury which is physical in nature. |
| What did Bill 164 create and what effect did it have on Accident Benefits claims? | it created the Statutory Accident Benefits Schedule (SABS) and allowed lawsuits for pain and suffering only. |
| How does the definition of threshold under OMPP compare to that under Bill 164? | Bill 164 makes no mention of "permanent" injuries and included impairment of mental or psychological functions. |
| What major changes did Bill 59 bring to Accident Benefits? | SABS was modified and suits for economic losses without meeting a threshold was introduced. |
| What changes did Bill 198 bring to Accident Benefits? | the right to recover medical expenses from an at-fault third party was included to the verbal threshold. |
| What rules currently apply with respect to recovery for economic loss? | recovery of loss income suffered 7 days after the accident was limited to 80% of net income. |
| What rules currently apply with respect to recovery for health care expenses? | legal actions for health care expenses were permitted if they met the verbal threshold. |
| What rules currently apply with respect to recovery for non-economic loss? | must be verbal threshold of a. death b. permanent serious disfigurement c. permanent serious impairment or an important physical, mental or psychological function. |
| What is the definition of impairment? | the loss or abnormality of a psychological, physiological or anatomical structure or function. |
| For the purposes of Accident Benefits coverage, who is an "insured person"? | a. any person listed in the policy as a driver of the insured auto b. spouse of named insured c. any dependent of name insured or spouse. d. involved in an accident involving he insured auto |
| Who, or what, determines from whom an injured person will collect no-fault benefits? | section 268 (2) of the Insurance Act sets out the rules that determine from whom an injured person will collect no-fault benefits. |
| State the priority of payments of no-fault benefits. | 1. claim accident benefits from own insurer 2. if person does not own vehicle, will collect from insurer of occupied vehicle 3. if auto had no insurance, recovery from the insurer of any vehicle in the accident 4. if all options used, will collect from the Ontario Motor Vehicle Accident Claims Fund |
| What is the function of a case manager? | they provide the coordination of goods or services provided by a medical, rehab or attendant care benefit. |
| What is the Minor Injury Guideline? | it sets out the treatment framework for minor injuries. |
| What is a "treatment and assessment plan" and who prepares it? | a document by a member of a health profession that outlines the impairment and the treatment details required. |
| How do Ontario Accident Benefits interact with those in other provinces? | Ont. residents injured have a choice between Ont. level of benefits or no-fault benefits in jurisdiction where accident occurred. |
| How do the benefits under the Statutory Accident Benefits Schedule (SABS) interact with social assistance payments? | auto insurer are the first payer of benefits to insured person who is also entitled to receive social assistance |
| What are collateral benefits? | are sources of entitlement outside of the auto policy. |
| How do collateral benefits affect payments under the SABS? | the insurer ay deduct amounts when calculating the amount of weekly income replacement or non-earner benefits. |
| How do Workers' Compensation and the no-fault benefits affect each other? | the insurer is not required to pay benefits to any person who is entitled to receive benefits from the workers compensation. |
| What document contains the rules for, and gives legal force to, the no-fault benefits? | the Workplace Safety and Insurance Act, 1997 |
| What no-fault benefits must every automobile policy provide? | 1. income replacement benefit 2. non-earner benefit 3. caregiver benefit 4. medical, rehab, attendant care benefits 5. payment of other expenses 6. death and funeral benefits 7. optional benefits |
| Who is eligible for income replacement benefits (IRBs)? | an insured person who is disabled as a result of an auto accident and meets the employment requirements. |
| Who is eligible for the Non-Earner Benefit? | payable to three classes: 1. do not qualify for an IRB 2. ceases to receive a caregiver benefit 3. were enrolled on a full-time basis in elementary, secondary or post-secondary education less than one year before accident. |
| For the purposes of Accident Benefits coverage, who is a "caregiver" ? | a person who incapable of providing caregiving activities to themselves or to dependents that they were engaged in prior to the accident. |
| Who is eligible for the Caregiver Benefit? | - person residing with a person in need of care - insured person was the pimary caregiver for the person in need of care |
| What optional coverage is available under Caregiver Benefit? | the ability to extend the caregiver benefit coverage to apply to situations where the claimant sustains non-catastrophic injuries |
| What expenses are covered by Medical Benefits? | medical, surgical, dental, optometric, medication, rehab etc. |
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