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No-Fault Benefits (Statutory Accident Benefits)

Obtaining Home Modifications or a New Home Utilizing these  Benefits Regardless of Fault

When a client has been involved in a car accident they are entitled, regardless of fault, to No-Fault or Statutory Accident Benefits (SABS). When a seriously injured client is being discharged from hospital or other facility these benefits can help both hospital workers and the patient in discharge planning on a number of levels. The no-fault benefits in appropriate circumstances may include entitlement to home modifications, home purchase, vehicle modifications and/or purchase (e.g. an accessible van) as well as income replacement benefits, housekeeping, visitor and other benefits. The process for obtaining these benefits starts with filing an Application for No-Fault Benefits. It also requires realistically an assessment by a home modification expert which will result in a Home Accessibility Report.

The enabling S.16 of the SABs states that all reasonable and necessary rehabilitation expenses are to be paid in order to reduce or eliminate the effects of an accident – related disability.  Home renovations, workplace and vehicle modifications, devices for facilitating use of the home, kitchen, etc. all represent items which may be claimed under that section as rehabilitation benefits.  More specifically, S.16(3) provides that home modifications and home devices, including communication aides to accommodate the needs of the insured person, or the purchase of a new home if “it is more reasonable to purchase a new home to accommodate the needs of the insured person than to renovate his or her existing home”.

Renovations of an existing home can include a rental property.  If it more appropriate to buy a new home rather than to fix a rental property, then with the appropriate expert assistance it may be possible to obtain and negotiate for the purchase of a modified home.

These benefits are only available generally to catastrophic injured clients who have been acknowledged by the Insurer as being catastrophic by definition.  They therefore have $1,000,000.00 worth of rehabilitation benefits, part of which can be used for home or car modification or home purchase if appropriate.  If the insured did not suffer a catastrophic impairment as defined by the SABs the maximum amount of eligibility for medical/rehabilitation benefits is $50,000.00 over ten years. Consequently home modifications would generally be possible but home purchase would not be. Minor Injury Guideline victims (generally whiplash victims) are limited to $3,000.00.

If the client is in need of home renovations or home replacement the first step is to obtain a home site and/or work site assessment.  Experts such as Scott Puddicombe generally conduct home site assessments to determine if the home is modifiable at a reasonable cost.  Assessments can be conducted of both the home site and work site as recommended changes to facilitate rehabilitation are usually being accepted by the Insurer.

The insured client will file an OCF-18 through their regulated health professional, this “Treatment and Assessment Plan” would identify the need and basis for the rehabilitation/modification of home, work or car which would then be submitted to the Insurance Company for approval.  The regulated health care professional must complete an OCF-18 to attest that renovations and modifications are both reasonable and necessary to accommodate the injured person’s needs.  A contractor’s estimate for completing the proposed modifications is generally attached to the OCF-18 in hopes of approval for the funding of the work to be done.

Our firm has acquired several homes for severely injured persons where the modification of their pre-existing home was not possible in the view of the assessment expert.

A Home Accessibility Report may also suggest modifications such as ramps, elevators and/or additions to the home.  It does not matter if the modifications or purchase of a new home result in betterment to the injured victim, the Insurer has no right to demand any or all of the sale price of the previously owned home if the home is replaced pursuant to the Home Assessability report’s recommendations.

The only downside to utilizing the SABs to acquire a modified or replacement housing in the appropriate circumstances is that a significant amount of the available policy limits for the medical/rehabilitation expense ($1,000,000.00 for catastrophic and $50,000.00 for non-catastrophic) may be used up.  Obviously the Minor Injury Guideline limit of $3,000.00 would be of no use in acquiring other than the most minor of modifications.

Nicholson Gluckstein Lawyers

Nicholson Gluckstein Lawyers
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