Benefits when you have a Vehicle Accident
When a person is injured in a vehicle accident, the constitutional accident benefit requires the automobile insurer to pay for non-professional healthcare services such as personal support and attendant care services, community and homemaking services. These services may be provided at home or in community settings such as supportive housing units, long-term care facilities and chronic care hospitals.
Clients who may require these services include those suffering serious physical injuries, closed head or acquired brain injuries and the elderly. Automobile insurers should arrange non-professional health services for their clients and pay the service provider directly.
The Ministry’s subrogation unit is responsible for monitoring compliance of payment responsibility for persons injured in motor vehicle accidents and who require health services. The Ministry of Health and Long-Term Care pays for automobile insurers pay for medical costs (all physician services), hospital services, mental health facilities, air ambulance and some professional health services such as nursing provided in the home, school or community.
When someone is injured in a motor vehicle accident, the priority of payment for healthcare services is
- organization programs OHIP services professional services administered through CCAC’s such as nursing, physiotherapy, occupational and speech therapy which is subject to eligibility and highest amounts payable
- private complementary health and disability insurer and private employer plans
- vehicle insurers accident benefits available through injured person’s own vehicle insurance policy
- money awarded in a lawsuit
- provincial government plans are the last payer for: non-professional services administered or provided through CCAC such as attendant care, personal support and homemaking
If the organization has provided services, such as attendant care or homemaking that should have been paid for by the automobile insurer, the ministry will seek reimbursement directly from the vehicle insurer. The vehicle insurer should contact the service provider directly to negotiate and pay for services. If your clients’ injuries are due to vehicle accidents, you should know which organization should be paying for required healthcare services.
Verifying that the client has been contacted the vehicle insurer for provision and payment of attendant care, personal support and homemaking services. If you have questions about health services and vehicle accidents, or would like more information please visit your lawyer for more legal advice. The information on this fact sheet is not intended as legal advice. It is based on legislation in the insurance act including the amendments. The contents are current as of today’s date but are subject to change. Readers should satisfy themselves as to the accuracy of the material at any particular time.
