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Jan 17, 2014

Proving attendant care gets more difficult for accident victims

The Ontario legislature has made changes to the Statutory Accident Benefits Schedule (“SABS”) that will impact the quantum of attendant care benefits available to victims of motor vehicle collisions.  The change come into effect on February 1, 2014 and health care professionals should be aware about the nature of these changes as they contemplate their efforts to serve motor vehicle accident victims.

The decision of Henry v Gore Mutual Insurance Company[1] placed insurance companies on the hook for the full amount of a Form 1, regardless of the actual economic loss sustained by a family member who stays home from work to care for an accident victim.  In Henry, the court determined that an “economic loss” served as a threshold for entitlement and not as a measure for quantifying an amount of reasonable and necessary attendant care benefit payable by an insurer.[2]

This will no longer be the case starting in February 2014.

The new changes narrow the definition of an “economic loss” to mean the actual income loss a family member sustains as a result of staying home to take care of an injured victim.

For example, despite a Form 1 indicating that a patient require attendant care in the amount of $3,000.00 per month, an insurer will only be required to reimburse the actual value of the wages or salary lost as a result of staying home to take care of a loved one.

  This change will drastically reduce the quantum of attendant care benefits available to accident victims.  As a result, families of accident victims stand to face even higher financial and emotional burdens when caring for a loved-ones post-collision.

 

[1] 2013 ONCA 480, online: <http://www.ontariocourts.on.ca/decisions/2013/2013ONCA0480.htm> [Henry].

[2] At para 22.

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