Your Eligibility for Income Replacement Benefits

Posted by Stevenson Whelton MacDonald & Swan
March 20, 2019

If you’re injured in a motor vehicle accident and can no longer work, you may be eligible to receive income replacement benefits.  Income replacement benefits are one of several ‘no fault’ statutory accident benefits (SABs) available under every Ontario vehicle insurance policy.

In Ontario, anyone who suffers an impairment or injury that was caused by the use or operation of a motor vehicle is entitled to make a claim for accident benefits.  This includes not only the owner or driver of the vehicle, but also passengers and others who were injured in an accident, regardless if they were directly insured under the vehicle insurance policy.  For example, if a pedestrian or cyclist is injured in a car accident, they may claim statutory accident benefits, including income replacement benefits, from the vehicle insurance policy of the car owner involved in the accident, or from their own insurer if they’re covered under any vehicle insurance policy. 

There are some exclusions for coverage under SABs rules. Specifically, drivers who are uninsured, do not have a valid driver’s licence, or were driving without the vehicle owner’s consent, are not eligible to claim for income replacement benefits.  Also, if the car accident was associated with criminal activity and the driver is convicted of a related criminal offence, then the driver is not eligible to claim income replacement benefits.  However, under any of these circumstances, an injured driver may still claim medical and rehabilitation benefits if they qualify with respect to their injuries.

How do I know I may be eligible for Income Replacement Benefits?

If you suffered a physical and/or psychological impairment caused by a motor vehicle accident, and your impairment prevents you from being able to work then you can claim income replacement benefits. IRB is available to people who were employed or self-employed at the time of their injury, or worked a minimum of 26 weeks within the year before the accident.  Your injury or impairment will qualify you for SABs if it results in “a substantial inability to perform the essential tasks of [your] employment”.

After two years/104 weeks, the eligibility requirements for IRB become more stringent – at this point, the claimant must be suffering from “a complete inability to engage in any employment for which he or she is reasonably suited by education, training or experience”.  

How much can I receive in benefits?

The amount that you can claim in income replacement benefits is 70 percent of your pre-accident gross income up to a maximum of $400 weekly, and benefits will begin 7 days after your accident.  Note that the amount of IRB you can receive is reduced by income replacement benefits you receive from other sources, such as a work disability plan.  IRB is generally paid out every other week.

After 104 weeks, the minimum weekly IRB changes to $185.

Persons over the age of 65 may be eligible to receive benefits for up to 208 weeks/4 years, at which point the amount of benefits is reduced.  And, if you turn 65 while receiving IRB, your benefit may be changed into a lifetime pension at a lower amount.

Termination of income replacement benefits for persons who initially met the eligibility requirements for IRB most commonly occurs at the two-year point, when the claimant must provide proof that their impairment prevents them from performing the essential tasks of any job for which they are suited.  If your benefits were denied at this point or for any reason, speak to a disability claims lawyer at Stevenson Whelton MacDonald & Swan to ensure that you have effective and strong representation against your insurer.

Disclaimer: Our blog is intended to inform our existing and prospective clients about topics pertinent to their lives. While our goal is to provide accurate and factual information, this in no way should be taken as legal advice or applied to specific cases. It is in your best interest to contact a licenced and practising lawyer for legal representation, as matters of the law are often complicated and cannot be fully assessed without knowing all of the details of a case.