When you’ve been injured in a car accident, whether as a driver, cyclist, passenger, or pedestrian, one of the most important legal tools available to support your recovery is Ontario’s accident benefits system.
Hosts: Hamish Mills-McEwan and Stanford Cummings
Topic: Civil Banter, Episode 7: Accident Benefits Bonanza – Part 2
In this follow-up to Part 1, Hamish and Stanford continue their deep dive into Ontario’s accident benefits system, this time exploring the key categories of benefits available to injured individuals after a motor vehicle accident. From treatment approvals to the role of occupational therapists, they walk through what these benefits look like in real life and how they actually get accessed.
They cover medical and rehabilitation benefits and explain what falls under the Minor Injury Guideline. They also take time to talk about pre-existing conditions, what “reasonable and necessary” treatment really means, and how to navigate the system when things aren’t straightforward.
A new segment makes its debut in this episode: You Auto Know, where Stanford tests Hamish on a real accident benefits case. The fact pattern? A cyclist, an oil slick, and the question of whether it qualifies as a motor vehicle accident under Ontario law. (Spoiler: it’s more complicated than you’d think.)
As always, the episode includes a dose of real life. Stanford shares highlights from a two-night Metallica concert in Toronto, while Hamish reflects on summer driving season and his love for six-speed manuals. It’s all part of the banter.
They close things out with a shout-out to Kevin Padley, who not only manages the Nelligators softball team but also delivers firm-wide, post-game recaps, and once wore the firm’s new mascot costume at a town hall.
Contact Information:
Email: civilbanter@nelliganlaw.ca
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Hamish:
I'm Hamish. This is Stan. This is Civil Banter with civil litigators at Nelligan Law, helping people through injuries, insurance fights, and life's legal curveballs with straight talk and a bit of banter.
So Episode 7, Part 2 of the Accident Benefits Bonanza. The keen-eyed amongst you will notice we're wearing the same clothes because this was in fact recorded on the very same day as Part 1.
Stan:
That's right. That's why it's a two-parter. That's what makes it so great.
Hamish:
Yeah, but that doesn't mean we're going to skimp.
Stan:
It's also a bonanza, so let's be real.
Hamish:
It's a bonanza. Yeah, we're not skimping. We're going straight into everybody's favorite segment.
Stan:
The LARPing segment.
Hamish:
Lawyers are real people. So Stan, how have you been spending your time? What have you been doing outside of work?
Stan:
Well, much has changed since the last episode. No, you know what? I had the real pleasure of seeing Metallica in Toronto for a two-night show. They're getting a little older, so the shows were spaced with a day off in between for them.
Thursday night and Saturday night, double show, no repeated songs. It was awesome. High-packed energy. Two hours each night for Metallica, and they had some pretty excellent openers as well. Limp Bizkit opened on Saturday. Fred Durst is looking a little like Santa Claus these days with a big white beard. But the crowd was really into it, especially on Saturday. Really good showing. Huge venue at the Rogers Center in Toronto.
They had a gigantic circular stage and two rings of floor seats. Well, not seats, no one had chairs. But they had an inner picture stage that looks like a donut. In the inside of the donut is the super fans. I don't even want to know how much those tickets cost, but they were in the circle. And then on the outside of the donut is everybody else who bought floor seats, just packed, just great energy.
They had these eight giant TV towers and they brought all their own sound gear in. So had some deep cuts, had some obviously the classic hit songs. And they brought it. For guys in their 60s, they killed it. It was great.
Hamish:
Was it your first time seeing them?
Stan:
No, I'd seen them four times.
Hamish:
Okay.
Stan:
Yeah.
Hamish:
Okay.
Stan:
But I'll see them anytime they're close by. My buddy, who I've seen them with on those previous occasions. He bought the tickets. He's part of their fan club and he got a great price on them. He paid less than what it costs for one show for both shows. So great job, Matt. Shout out to Matt on that one.
Hamish:
Nice. Yeah, I think it's one of those things where there's a level of their age increasing, but the care for the production.
Stan:
They'll have money they didn't have in the '80s to put a great set together.
Hamish:
Right. Just higher and higher. A two-day set is insane.
Stan:
Yeah. They could have played four nights, five nights with no repeats and still had a great show. I'm a big, big fan, so I like the deep cuts on some of those albums. There were still certain albums they didn't play any songs off of.
So that's what you get when you've been at it for as long as they have. And they're just so good. Sometimes you go and the band isn't super tight, but they can't get away with it. The fan base is too big and they're too good at what they do.
I used to play bass in high school and my bass teacher-
Hamish:
Oh, yeah? I didn't know that.
Stan:
... he said, "Metallica's got to be really tight because their fans are so great that I bet you if they threw a guitar into the front five rows of their concert, that at least half the people there could probably pick it up and play decently." Not as good as, but-
Hamish:
Just substitute in.
Stan:
... Yeah, so they're full of a lot of metalheads and real musician fans.
Hamish:
Technical metalhead.
Stan:
Yeah, so that's why they have to be as good as they are. How about you?
Hamish:
Well, I just wrote down the following words. I wrote down summer car selling season and six-speed manual transmissions.
Stan:
You did what? Capital S on the end of that one. That's great.
Hamish:
And the point is, in Canada, the winters are not fun for most drives.
Stan:
Rear wheel drives, ice, snow, not good friends. If you've got a muscle car or a sports car and it's rear-wheel drive.
Hamish:
No [inaudible 00:05:08].
Stan:
Driving around here is not great In the winter.
Hamish:
There's fun to be had, but there's also immense levels of stress that correspond with that fun.
Stan:
Right. It's fraught with danger.
Hamish:
Fraught with danger but something about ... My car right now is automatic and I just miss six-speed manual. I just need manual transmission.
Stan:
You're a proper English man.
Hamish:
I had a crisis of confidence when I was about 26 where I always thought about myself as someone who liked cars, was interested in cars, liked motor sports, but I could only drive automatic.
Stan:
I could see how you would start to get a little antsy about that.
Hamish:
And it was, I think-
Stan:
It's like the Metallica thing. Where are you a true fan if you can't play some of it?
Hamish:
... I felt like it was a dereliction of my duty as an Englishman. So I learned six-speed manual in the best way you can do it, which is one, have a father who is competent and a good teacher.
Stan:
An Englishman.
Hamish:
And an Englishman and a good instructor. And you just have to go from never having driven it to you just have to start driving it. And you have to drive it every day. And it's immensely stressful. And every time I got out of the car, my heart was just beating just from pure stress.
Stan:
Yeah. How many clutches did you destroy in your learning?
Hamish:
Didn't destroy any clutches, but yeah, you're hard on a car at first. But I don't know there, there's something about, I think it comes down to there are many times if you drive manual when you're like, "Why on earth do I do this?"
Stan:
Hill starts.
Hamish:
Hill starts, rush hour traffic, Queensway at 4:00 through 6:30 PM. But it just does not allow you to not focus.
And if you're quirky like some of us are, when you just know that you need to focus. And you're engaged in doing something and you cannot daydream because you have to focus, it just makes it more enjoyable even doing the boring stuff in a boring car if it's manual transmission.
Stan:
Well, now I want to know the stats about motor vehicle accidents in jurisdictions that are primarily standard transmission versus here in North America where everybody's got an automatic transmission car. Are they less likely to crash because they're actually paying attention to the road as opposed to day drifting with their automatic transmission?
Hamish:
Interesting. And another thing is by convention. So examinations for discovery when we're questioning a defendant who we say is responsible for a car accident that injured our plaintiff. Over the years on so many question guides, which we look at, just notes about what questions to ask. They're more standard questions. You use them sometimes, sometimes you have more of your own.
But the number of question guides I've looked at, one of the questions is, "Was the car you were driving manual or automatic?" And I've seen that on so many question guides. I've never seen that ever come up as a factor in any case, but I've seen it in dozens of question guides.
And I don't really know what the implication there is and why so many lawyers have that in their standard list of questions. I still ask it, but I'm actually just interested in knowing. I'm just making conversation.
Stan:
You'll know. You're not going to have a standard transmission Dodge Caravan. It's not going to happen.
Hamish:
Okay. Anyways.
Stan:
Well, you said, hold on. Let's see, summer's car selling season six-speed manual transmission. Take us back. Is this just thoughts you were having?
Hamish:
These are just thoughts I was having. As soon as the snow starts to thaw, I start thinking about maybe I need a car that is manual transmission. And maybe I need to get rid of my car that is not manual transmission and acquire one that is manual transmission.
Stan:
Yeah, no, I get it.
Hamish:
That's how it goes.
Stan:
Maybe with or without a roof on it.
Hamish:
With or without a roof. We'll see.
Stan:
That's summery, convertibles
Hamish:
Summery, but also we do have to realize that we live in Ottawa and that summer season is extremely, extremely, extremely short and fleeting.
Stan:
Yeah. Well, I like it. Update us if you buy a six-speed standard transmission.
Hamish:
I'll update you the first time I stall it and it makes me extremely embarrassed.
Stan:
How long has it been since you drove a standard?
Hamish:
I think the last time was on vacation in Greece.
Stan:
Europe, right? Always got to be Europe with the standard transmissions.
Hamish:
Yeah, and it was a car that ... I consider myself to someone who knows all cars. I have no idea what this was. I've never seen one before. It looked like a cartoon car. It was-
Stan:
Soviet maybe?
Hamish:
... I don't know. It was tiny. It was very, it was just shaped like a right angle triangle. It was absolutely tiny.
Stan:
I'm getting Soviet vibes, Eastern Bloc vibes on this. Maybe it was like a Skoda or something.
Hamish:
Possibly Skoda. Anyways, it did the job but it was sloppy.
Stan:
It had seen things. It was a rental?
Hamish:
It was a rental.
Stan:
Yeah, it had seen things for sure.
Hamish:
And just driving around this island and just driving on this island was absolutely hair-raising.
Stan:
But idyllic in many ways, I would hope.
Hamish:
It was idyllic, but it was nerve-racking for sure. The way Europeans drive is, I tip my hat to them.
Stan:
Yeah, for sure.
Well, we blathered on long enough in the LARPing section, so I'm going to introduce a new segment. That's right, a new segment. We referred to it last episode where the table will be turned and I will be the one testing Hamish on this one.
Hamish:
[inaudible 00:11:10].
Stan:
I think this segment is called You Auto Know, A-U-T-O. So You Auto Know. And in this segment I will be testing Hamish on whether or not a person was able to successfully claim accident benefits. The test that is applied is whether the person was injured as a result of the use or operation of a motor vehicle.
So we went on at length last episode. If you haven't listened to it, I encourage you to do so that there are benefits available to people who've been injured as a result of using a motor vehicle. And so how far does that go? Is something we're going to be finding out in this.
Hamish:
We said it was a safety net. How far does that safety net stretch?
Stan:
That's right. How wide is it?
So in this particular segment I found a case. This one's fairly recent, it's from 2023. And I'll go through the facts with you. It's called Kopylets, C-O-P-Y-L-E-T-S or Kopylets maybe and Primmum. And for those interested, the citation is 2023 CanLII 65759.
And in this case, the claimant, Julia Kopylets, was riding a bicycle with a group of cyclists. She was in Halton region and while making a right-hand turn, the bicycle lost traction on a fluid deposit on the road and she fell and she hurt herself.
Pretty significant injuries here. Fractured collarbone, pelvis, shoulder blade, and a collapsed lung. So Ms. Kopylets really had a rough go as a result of this fall. I'm imagining a very racy bicycle with very thin tires and perhaps high speed.
Hamish:
On a road?
Stan:
On a road where she's legally entitled to be along with a group of others.
So there's a witness to this, a retired police officer who happened to be riding in the same area and he observed the group of cyclists. He saw three cyclists fall, so not just the claimant in this case. And he went over to assist and investigate. And he noticed that there was a damp, slippery substance on the road that smelled of petroleum.
So he followed the fluid trail to a nearby property, was unable to confirm that its source was a vehicle on that property. And was involved in a somewhat aggressive encounter with the property owner who I'm sure told him to take a hike. That part's not really necessary, but it is a nice fun sidebar.
So there were photographs that showed this dark stain on the road. Essentially, it's oil. We're going to consider it to be oil. I don't see any reason it would be anything else. There were witnesses, both the claimant and this retired police officer who said it seemed like oil. It smelled like oil, looked like oil, but nobody took it to a lab to confirm that it was indeed oil.
The premise is, and the claim was, that the claimant fell off of her bicycle because oil had been deposited on the road by a vehicle of some kind. And that is, as a result of the normal use of an automobile, there can be fluid leaks, oil leaks, hydraulic leaks, et cetera. And that normal use resulted in her fall and therefore, the injuries she sustained were because of the fall. And the fall was because of the oily substance on the road.
So she applied for accident benefits saying, "My bicycle accident, which I wasn't hit by a car on but I slipped on the road, was caused by the normal use and operation of a motor vehicle."
And this is the part where Hamish has to decide, did the tribunal in this case say, "Yes, this did arise as a result of the normal use of a motor vehicle. And yes, your injuries were caused as a result of that incident" Or, "No, this really is just a biking accident. You should have looked where you were going. People on bicycles fall on gravel, they hit curbs. It doesn't have to do with a motor vehicle."
So there you have it. Any other questions? I think I summed it up pretty well.
Hamish:
I think I'm just going to make statements and then gauge your reaction and see if I can-
Stan:
Oh, now it's a test of poker face as well.
Hamish:
... Okay. So this is what I'm thinking. Now I know it's a broad test, but I can't go over the evidentiary hurdles to me. When I hear this, I think there aren't enough known facts from which we can draw conclusions. So when I hear this, I think it's not clear that the fluid ... Well, firstly, it's not clear that it was necessarily gas versus petroleum versus some other petrochemical.
It's on the road, but there's no information about how it got there. And to me not knowing how it got there means that you could drop anything from a vehicle. You could be transporting pails of mayonnaise in a vehicle. And if mayonnaise fell out of your truck and there was a mayonnaise spill on the ground, I think if a cyclist took a tumble because they spilled on mayonnaise, I don't think someone would say that would meet this test.
So someone could have sloshed oil or petrochemicals on the ground in something that I think is very far removed from a vehicle. And the answer here is it's just not clear how it got there and it's not that clear what it is.
Stan:
If you accept that the oil got there because of a car, does that change your analysis? How else is oil going to get in the middle of the road?
Hamish:
It does if we knew that information. I think if, let's change this. A car is driving in front of the cyclists, you can see oil dripping from the undercarriage. It drives away the same thing happens. Someone takes a tumble on this. I think that would be meeting this test and they would be entitled to accident benefits. So I think it hinges on that part whether or not we know it came from a vehicle.
Stan:
So in this case, the evidence was they had a photograph of it, they had three people who said it smelled of petroleum and looked like petroleum. And then they have a retired police officer who comes over, follows the trail up to a neighboring house and then gets into an altercation with the property owner. So is that enough?
Hamish:
I'm going to live and die on my principle of what I think should happen.
Stan:
All right.
Hamish:
And I think what should happen is I don't think there is enough evidence here to say that this necessarily came from a vehicle versus a lawnmower.
Stan:
Right. Which would be a weird place to have a lawnmower in the middle of the road.
Hamish:
You're dropping some hints and I'm going to say, yes. Yes, the cyclist was entitled to accident benefits.
Stan:
They were. I leaned into it, yeah.
Hamish:
It is what it is. Good, in terms of expanding the safety net. Having not read the decision and being primarily plaintiff's counsel ...
Stan:
You like it.
Hamish:
I like it. I would rather-
Stan:
I think the mayonnaise example actually plays on this where how else could, I guess someone could have hucked a bucket of mayonnaise into the road. But if it fell off a car and that car was normally transporting that thing, then I don't think it has to be restricted to oil or gas. I think any slippery substance that falls off of a vehicle and that so long as it's normal course of operation.
Hamish:
Right. You do think about so many commercial vehicles on the roads, pickup trucks transporting stuff. If you transported a plank of wood in your truck and it fell out the bed and someone rode over on a bike. Then yeah, I think this would be an accident that resulted from the ordinary activities in an automobile. And there was a causal relationship between the injuries and the use operation of the vehicle.
So if that's in, then dropping oil should be in. And if it's an oil leak, that should probably be in too. And then if you just don't happen to ... It not being seen or witnessed that a vehicle in fact deposited it is where I get hung up. But lesson learned.
Stan:
I think this is one of those circumstances where the tribunal's going to probably bend over backwards to see a pretty horribly injured person and say, "Yeah, I'm going to stretch what maybe might not be accepted as evidence in court. Is it more likely than not that this is actually oil?"
I think honestly on these facts it probably is. You've got four people, one of whom's a retired officer with no skin in the game saying, "It looked and smelled of oil." That might be enough. There's photographs that it was there and two other people also fell. I think that combined is enough to tip the scales here.
Hamish:
And we will get into this in the later date. But that touches on two things. One, the human element of all decision making, whether it's a judge making a decision or an adjudicator or tribunal. Her injuries and the severity of them, I refuse to believe they don't come into the picture in terms of the decision making.
And when someone's seriously injured, and if they're seeking coverage under a policy and the purpose of the policy 0.2 is consumer protection, which it is. It's been well established that the accident benefit scheme is about consumer protection.
Stan:
Right, she's paying premiums.
Hamish:
This is why it might seem, even in my own estimation, like a stretch. Why this is something where that is going to be coverage and she is going to be able to claim medical and rehabilitative benefits to assist in her getting back to her ordinary self to the extent she can.
Stan:
I imagine that was quite a lengthy recovery given the significance of the injuries. But a great case to start off this, You Auto Know segment, on. I'm sure I'll find even weirder cases out there.
But this one I thought was an interesting one because no car was seen or actually involved. She wasn't hit by a car, just slipped on some residue. So there we have it. You Auto Know Part 1, that's a win for you.
Hamish:
I think it was only just. Okay. I'll take it. I'll take the win.
Stan:
Yeah, take the win.
Hamish:
Okay. So we're about to get into the meat of this with Part 2 of the Accident Benefits Bonanza.
So while we left off last time, we were talking about specified benefits being income replacement benefit, non-earner benefit, caregiver benefit. And now we're going to go into medical and rehabilitative benefits.
So as we discussed last episode, this is not where you get cash or checks from the insurance company. This is why you have a treatment provider like a physiotherapist and they send a treatment plan of what they intend.
Stan:
The recommendations, essentially.
Hamish:
The recommendations. They send it to the insurance company. The insurance company says, "Yes, we approve it," or, "No we don't," or, "We approve part of it." And then the treatment provider is paid by the insurance company to affect the treatment.
Stan:
And so medical and rehabilitation benefits are available to injured persons, so long as they're reasonable and necessary.
So if you can say to the insurance company, "Hey, I really need this round of physiotherapy to get over the injuries that I've sustained." And it's reasonable, it's for a round of physiotherapy and it would help you get over those things. Then they will be funded by your automobile insurance provider.
There are tiers of available benefits, and I don't mean, E-A-R-S, T-I-E-R-S. So what there are is everybody in the province who's been in an accident who needs some medical treatment is guaranteed to get funding up to at least $3,500, regardless. That is open to anybody, even if they've sustained relatively minor injuries. And this initial $3,500 limit is called the Minor Injury Guideline. Why don't you tell us a little bit more about that?
Hamish:
Right. So the Minor Injury Guideline has a definition in the schedule and it's a specific definition covering only these things. And it is sprain, strain, whiplash-associated disorder, contusion, bruising, abrasion.
Stan:
Scuffing.
Hamish:
Scuffing, yeah, scuffing. Laceration cuts or subluxation, which we learned.
Stan:
Partial tear? Partial dislocation.
Hamish:
Partial dislocation. Partial but not complete dislocation. And it includes any clinically associated symptoms. So that's all it covers. And if you're talking about what isn't covered and what brings you out of that $3,500 limit ... And what I mean not covered, what I mean is you get into the next higher tier of benefits if you have one of these.
Stan:
Right. The standard policy would provide for $65,000 of non-mig. Just to give people an example, say in the case we just discussed with the You Auto Know section. If the claimant in that case had fallen off her bicycle at a low speed and scuffed her knee and bruised her thigh, then she would in all likelihood have sustained a minor injury because she would have had an abrasion or a contusion. And her available funding would have been capped at $3,500.
So that's a handy example of you can see if someone involved in a relatively low-speed incident falls off a bicycle or something, minor injuries, she gets up to $3,500 worth of treatment. So that's how the Minor Injury Guideline works.
Hamish:
And then also, if you think a really non-serious car accident when just the extent of it is my neck's sore.
Stan:
Yeah, you got jostled a little bit.
Hamish:
Yeah, you have whiplash and that really is it.
Stan:
So physio and maybe a massage would help and you go get that funding and treatment.
Hamish:
And $3,500 completely could be enough if that's all you're suffering from. But if it gets anything outside of this list, then the tier is now up to $65,000 benefit, so huge jump.
Stan:
Yep. And that's really, as you said, anything that isn't a minor injury is out of the guideline.
Hamish:
and that is five years from the date of the accident in which you can claim benefits up to that cap.
Stan:
That's right. There's a time cap and a financial cap on non-Minor Injury Guideline claims.
Hamish:
And so we're talking concussion.
Stan:
Broken bones.
Hamish:
Broken bones.
Stan:
Psych injuries.
Hamish:
Yeah, psychological injuries. All of these things bring you out of the Minor Injury Guideline and into the $65,000 of accident benefits coverage, which you are entitled to claim.
Stan:
That's right. And you can seek treatment from a number of different providers in this bracket of treatment. You can go to physio, you can go to chiro, massage, psychological services, occupational therapy. It's really almost an endless list.
As long as you can prove that it's reasonable and necessary, then there will be funding perhaps afforded to you. They might deny it and you'd hire a lawyer or fight it yourself, but you can seek funding for anything that might be reasonable and necessary.
Hamish:
Now what happens if I'm in an accident and I'm your bicycle example where it was a lower speed? And there's no broken bones, but I have bruises, cuts. I have road rash, I have a really bad neck strain. You'd think I'd be in the Minor Injury Guideline. But what if three years before that I had a really catastrophic workplace accident?
Stan:
Well, you can actually be removed from the Minor Injury Guideline as a result of a previous injury that would impact your ability to recover within the guideline. And great case that you just put forward there. Great scenario.
If you've been injured or if you have a pre-existing condition, it doesn't even need to arise as a result of an injury or an accident. If you are a psychologically vulnerable person and you're involved in an accident, then that can be a factor. If you have a very bad back and it's been documented that you have a bad back, that you'll need more physiotherapy than the average person would, that would be probably enough to get you out of the guideline.
Hamish:
If you've pulled the same muscle multiple times before and then you're in an accident where you pull that same muscle again? There's a good chance that we could say that there's a pre-existing condition that's going to basically extend the time that this is going to take to recover from. So while it's within that list, in terms of the injuries, it's not reasonable to assume that someone's going to get better with that level of funding only being $3,500.
Stan:
That's right. And there's now, well, there's not, now. There's always been. There's a third level of benefit under the medical and rehabilitation heading that is over and above the $65,000 limit. And what level is that?
Hamish:
That is if you have a catastrophic impairment designation, and in that situation, the time limit of five years from an accident, that's gone.
Stan:
Lifetime.
Hamish:
Lifetime benefits, and the benefits you're entitled to claim under the coverage is up to $1 million. So again, in the same way there's a huge jump from the Minor Injury Guideline to the standard $65,000. If you have a catastrophic impairment, you can claim medical and rehabilitative and attendant care benefits up to $1 million.
Stan:
That's right. And we're not going to get into the catastrophic issue this episode. That will probably be its own episode. We mentioned in our previous episode, it is what it sounds like.
So if you are catastrophically injured, if your accident resulted in horrific injuries, then you will be eligible for this enhanced level of funding. Getting back to the social safety net and the consumer protection. It's there to get you over or through, or at least maintain a level of recovery that you wouldn't be able to do with $65,000 worth of benefits.
Hamish:
And so we touched on some of the types of medical and rehabilitative benefits, but what types of treatment providers? Let's say you're in the Minor Injury Guideline or let's say you have had a full dislocation or you've had a fracture. What types of treatment providers can you go to and essentially ask them to treat you and have your insurer pay for that treatment?
Stan:
Yeah, we work primarily with folks like occupational therapists, physiotherapists, chiropractors, massage therapy. That's not an exhaustive list of it, but those are the big ones.
And they're there to provide people with the kind of care that will help them get better, basically. And they will assess the claimant and make a determination about what kind of treatment might be necessary, and then propose that. And the insurer will make a decision from there.
Hamish:
Now, out of all of those, the one that was newest to me when I came into this field was occupational therapists. So neither of us will be able to give a perfect definition.
Stan:
That's right.
Hamish:
Because we don't work in the field. But having been exposed to it and work closely with occupational therapists who by and large are just lovely human beings.
Stan:
They really are.
Hamish:
How would you describe the work they do for someone who's not familiar with what an occupational therapist is?
Stan:
They do some really incredible stuff in terms of getting people back to work and in workplace environments. In home environments, they do determinations about things that somebody might need in terms of assistive devices, in terms of assessing their care needs, which might be a nice segue into the attendant care benefits.
But OTs will meet with claimants and put them through a pretty rigorous assessment both in terms of their physical capabilities and their cognitive capabilities. And make a determination about what kind of things they might need to get better and provide them with the tools to do that.
Hamish:
And it's quite holistic in terms of getting someone back to their activities, whatever their activities may be. So you touched on just then attendant care benefits.
Stan:
These are separate and distinct types of benefits. So they're not medical and rehabilitation benefits, they're somewhat related to it. But they are basically, to have an attendant, it's in the name, look after somebody who's been involved in an accident who is unable to look after themselves fully.
PSW for example, although it's not restricted to that. But that's the main example, is that a person who's trained to help somebody with their mobility, with their feeding, with their care. They'll come in with an assessment of how much attendant care somebody needs, which is done by an occupational therapist.
They'll come in, they'll assess the person and they'll say, "Well, this individual requires a certain number of care hours per week." And then an attendant is hired to come in and provide those services.
Hamish:
And you can imagine a situation where someone's lost the use of that dominant hand or something, how difficult that would be. Or if someone already had mobility issues before an accident and then they're injured and their mobility is even more decreased.
Stan:
Or a seriously fractured leg will certainly impact your mobility around the home.
Hamish:
Balance issues is one of the ones that is not something I straight away think attendant care. But after an accident, if someone has concussive symptoms there can be vertigo and balance issues, which then can be risky in and of themselves.
Stan:
And with injuries to things like hands meal prep, very challenging, things like that. There's also in certain cases where somebody has sustained significant psychological injuries and impairments.
An attendant to be in the home with somebody like that is important. And can provide everybody involved, family members, et cetera, with peace of mind so that they can go out and work and support their injured spouse knowing that there's a care provider there.
Hamish:
And then, so we've essentially covered off most of the big ones. There's also a housekeeping and home maintenance benefit, which that is something you're only entitled to claim if you're at that $1 million catastrophically impaired level. And that's $100 per week. And that is stuff like cleaning.
Stan:
Yard management, lawn cutting, snow removal.
Hamish:
Yeah, the stuff where it's the upkeep. And that's obviously dependent on someone's living conditions. What someone's needs would be in that situation. But that's something that it's not a lot in terms of the dollar value. But it's important to know that if you are at that highest level of catastrophically impaired, you can have someone come in and take care of some of your housekeeping needs.
Stan:
That's right. Then there's a number of benefits that maybe don't immediately jump out even to people who practice in this area but are available under the legislation. Things like, if you sustain damage to clothing or property as a result of the accident, then your insurance company will pay you for the damaged items and replace them.
An example that I have is a file I worked on, injured. A person was snowmobiling, automobile counts, so snowmobiles, ATVs, those types of things. And really unfortunate injury, a significant leg fracture. And had to have his very expensive snowmobile outfit cut off of him by the paramedics. So he was very well-equipped with appropriate snow gear and it was all rendered useless. And so the accident benefits carrier funded the replacement of the clothing.
Hamish:
Right. And so yeah, these are all more niche things that don't come up in every case, but that's a good example. Another one that I've dealt with before, lost educational expenses. So having had a client who is enrolled in courses at a college or university and as a result of the accident, essentially was forced to drop out after the drop by date. So they had to pay the tuition for that semester, and then just couldn't attend classes and couldn't do that.
Stan:
Right. So this is there to say, "Okay, you're out $5,000 for this semester of school, you can't recover it, we're going to pay you for that."
Hamish:
And then in the case of fatal accidents, there are still accident benefits there in terms of family members being able to have some of their funeral related expenses covered.
Stan:
Yeah, there's a death and funeral benefit. There are two different ones. So there will be some, these days funerals can be very expensive. It's not enough to cover probably most funerals, but there is some money available from the accident benefits there.
And there's a death benefit paid to certain family members. We don't need to get into that, but it's who you would think children and spouses and things like that. And so that's one available benefit that maybe not everybody thinks of. Obviously, your mind's in a different place if you've had a family member involved in a fatal accident.
Hamish:
So that about rounds out our discussion on the Accident Benefits Bonanza. There are so many more topics we can and will go into including, we'll talk about the tribunal.
Stan:
Assessments. We haven't gotten into assessments, but that's huge and that's where a lot of our clients, majority of their stress comes from, is having to go to these assessments.
In short, your insurer can say, "Well, I don't know if this is a reasonable and necessary medical benefit." Or, "I don't know if you're still suffering a substantial inability to carry on your regular employment. So I'm going to hire a medical professional to assess you."
And then they have the right to do that, and they can subject you to an assessment. You can also say, "I want my own assessment done. I would like a diagnosis and a prognosis, and a plan for getting better." And there is available funding for that as well.
Hamish:
Right. So yeah, that ends up being a lot of what happens when it can ... And sometimes there can be assessment after assessment after assessment. And having a lawyer involved really is helpful for making-
Stan:
Do I have to go to all of these assessments?
Hamish:
... Exactly. If you have seven back-to-back assessments in a short space of time. If I'm having assessments, but the expertise of each assessor is duplicative. I don't necessarily need to go to every assessment. That's not reasonable.
Stan:
Or they're proposing the wrong type of assessor.
Hamish:
Exactly.
Stan:
If you're dealing with an injury that would best be assessed by a neuropsychologist, but they send you to maybe just a neurologist or just a psychologist. You can turn around and say, "It's not the right assessor. They're not going to come to the conclusion that would be most accurate."
Hamish:
Yeah. So where an insurer can really bamboozle someone and make them be put in a situation that's not advantageous, that's where we can be a check. And come in and make sure things are proceeding in the way they should and have to. And that the insurance company is being fair to you.
Stan:
Absolutely.
Hamish:
And when we can't resolve our disputes by phone calls and keeping things friendly, that's when we go to the tribunal that governs and decides disputes between insurance companies and their clients, essentially. And we represent people there.
Stan:
It's one of those rare times where you can go to a dispute about a mutual client because they're our client and they're the insurance company's client.
Hamish:
And then the final thing I'll just flag is that there are some big changes coming to the accident benefits regime, at least in terms of what benefits are optional and what benefits are mandatory.
So I believe it's July-
Stan:
2026.
Hamish:
... Yeah, July 2026 is when these changes are coming. So the province is going to be implementing these changes that basically in a sense give you more choice. And by that, you can forego having income replacement benefits.
Stan:
Right. If you are retired and you know for sure you're not going to go back to work, then maybe not paying to have income replacement benefit coverage makes sense for you.
We're not brokers, we're not insurance advisors, so we're not necessarily telling you what the right coverage would be for you. Also, these are all future changes coming. But I think it highlights the importance of making an informed choice.
And that, when you give people more choice, it helps those who are able to make an informed choice. But for those who may simply want the cheapest insurance without understanding why a more expensive policy may be beneficial to them. They could be in a position where they don't have access to benefits because they've opted for a cheaper policy.
Hamish:
Right. And I think that's the thing. I would say, I am generally agnostic on these changes. It's not taking away something, but it means people have to be more informed than they otherwise would to make sure they are making the right decision about what benefits they should and should not be selecting. And that's why it's critical that definitely before July 2026 and every year.
Stan:
Every year, consult with the right people and find out what you should get covered for.
Hamish:
When your insurance policy renews, read it.
Stan:
Read it.
Hamish:
Have a look through, make sure that what you're paying for is what you want and what you think you need, and ask appropriate questions.
Stan:
If you don't know, look into it.
Hamish:
Okay. And with that, that ends our Accident Benefits Bonanza, and we're going into shout-outs.
Stan:
And this time I'll be leading a shout-out. So we are lucky enough at Nelligan Law that we have a pretty large roster of employees and folks who work at the firm. And thus, are able to field a softball team. I love softball, I play it a lot.
And we have an excellent manager of that softball team, Kevin Padley who is in the thankless job of herding around all of the many people who work at the firm who have indicated they want to play softball. And making sure that we show up to games on time, we know where the games are, we know what time to get there.
And for some of the folks who are just playing, maybe their first year of softball, really patient teacher for those folks. And I like to think I can be and am as well. So he does a great job coaching that team. In softball, baseball, they're called managers, but he's the manager of the team. He also plays, so he's very good at softball as well.
Hamish:
And he's a master motivator. And he's well-known in the firm for my favorite thing, which is his after-action reports. After every game, he gives a detailed comedic and motivational play-by-play of exactly what happened. We all get the firm-wide email, so we're all up to speed. And what is the name of Nelligan's softball team?
Stan:
We're the Nelligators. And funny you mentioned his summaries. Those are AI-generated summaries because Kevin goes to the very difficult time-consuming task of tracking every single hit-and-run that is scored, down to where that hit landed in the field. So that an AI program can sum it all up and tell you what happened in that ballgame.
Hamish:
Okay.
Stan:
Yeah, so that's a pretty smart use of AI.
Hamish:
I like it a lot. I like it almost as much as at our last Nelligan's town hall when Mr. Padley came out in a full Nelligator regalia.
Stan:
Our mascot uniform, which is new this year. And which I think is best seen in person and will be featured at our games. So if you want to come to a game and see Kevin's wonderful mascot outfit, I don't know who'll be wearing it. It won't be him. He's going to be managing and playing.
Hamish:
Maybe that's a job for me.
Stan:
You could be the mascot. Absolutely. He said it was nice and cool in there, which I find shocking. But who am I to doubt him?
Hamish:
Okay, so with that, we'll say our goodbyes. You can find our team at nelliganlaw.ca. You can find Stan on his newly minted LinkedIn at ...
Stan:
Linkedin.com/in/stanford-cummings.
Hamish:
And I'm on LinkedIn at linkedin.com/in/hmillsmcewan. If you have comments, questions, suggestions, topic suggestions, if you want to be a guest, which we'll be introducing down the line.
Stan:
Yeah. If we talked about any area that you practice in. If you're a service provider and you want to come on and talk about the excellent work that you do and the options that are available, shoot us a line.
Hamish:
Yeah. Come educate us and come educate our listeners. You can shoot us an email at civilbanter@nelliganlaw.ca. And like, comment, subscribe, share with all your friends and family. That's a wrap.