Personal Injury Limits in Key Canadian Provinces

Personal injury lawyers are looking to provide services to motor vehicle accident (MVA) plaintiffs in other provinces. This article provides a brief overview of current legislation.

Quebec and Manitoba have government-run pure no-fault insurance regimes, with no right to sue for pain and suffering nor for economic loss beyond the no-fault benefits.

Saskatchewan also has a government-run system which lets motorists choose between a no-fault option (which is selected by more than 90% of drivers) or a tort option. Under both options, drivers have the right to sue for economic loss. The few motorists choosing the tort option can also sue for pain and suffering (subject to a deductible).

In Saskatchewan and BC, the government-run insurance provider competes with private insurers for optional and additional coverage.

British Columbia’s no-fault system allows claims for pain and suffering. Third party liability is applicable only in certain situations. Basic insurance is provided by the government’s Insurance Commission of British Columbia (ICBC). We reported earlier on constitutional challenges to BC’s system.

Ontario and Alberta are the largest provinces with private auto insurance administration, but as we reported earlier both provinces are looking at changes. Currently, injured plaintiffs can sue for pain and suffering (with some limits, depending on the injury’s severity) or for economic loss. Both provinces have studied changes to their auto insurance regimes. In March 2021, the Financial Services Regulatory Authority of Ontario (FSRA) looked at the mechanics of limiting or removing the tort process. In 2020, Alberta released a report that recommended a no-fault auto insurance system, like that in British Columbia.

Drivers in the Atlantic provinces and the northern Territories buy coverage from private insurers and have rights to sue.

Here is a summary of some injury coverage in three key provinces:

British Columbia

Enhanced Accident Benefits (EABs) supports injured plaintiffs in accessing medical care, recovery, and income replacement benefits for as long as they’re needed, up to their lifetime. Catastrophically injured people are eligible for a lump sum permanent impairment benefit of $288,144. For a non-catastrophic injury, the minimum payment is $911 and the maximum $182,483.

EABs cover out-of-pocket expenses such as travel and accommodation for family members or friends visiting a close relative who has been hospitalized and is in critical condition because of an MVA. Expenses are covered up to $5,420 for one person, or up to $2,710 per person for two people.

The Recreational benefit helps the plaintiff (and a companion or assistant, if required) to participate in recreational or leisure activities which need extra support, or that incur extraordinary expenses. This benefit is available for injuries resulting in a permanent impairment of 20% or more. The amount of the benefit is determined by the percentage of impairment, ranging from $545 up to a maximum of $4,359 every two years for catastrophic injuries.

Secondary school students who miss a full year of because of injuries sustained in the MVA receive a lump sum benefit of up to a maximum amount of $11,496 a year. For post-secondary students who miss a year of school, the amount is $22,992.

Personal care assistance covers the expense of hiring someone to care for the plaintiff if their injuries (physical or mental) sustained in a crash prevent them from caring for themselves. The level of coverage depends on the extent of the assistance required:

• Non-catastrophic injuries: up to $5,484 per month
• Catastrophic injuries that do not require 24-hour care: up to $6,558 per month
• Catastrophic injuries requiring 24-hour care: up to $10,897 per month

Care expense reimbursement helps to pay for someone to take over caregiving duties if the injuries sustained in the crash prevent the plaintiff from performing them. The maximum care expense amount:

Caring for:	Weekly amount:
1 person	$159
2 person	$202
3 person	$246
4 person	$289

Income replacement benefit is based on 90% of net income, less any amounts payable from other sources, and based on a maximum yearly insurable income amount. As of April 1, 2023, this amount is $109,000.

For more information: https://www.icbc.com/claims/injury/Documents/your-guide-enhanced-accident-benefits.pdf

Alberta

The Automobile Accident Insurance Benefits Regulation is mandatory in every policy in Alberta. Section B Accident Benefits are available to anyone injured in an MVA. These benefits allow accident victims to access treatment for their injuries without having to wait for the outcome of a personal injury claim. The policy is not responsible for any services that are covered under any other provincial health insurance plan or employee benefits plan. The benefits include all reasonable expenses incurred within two years from the date of the accident for necessary medical treatments, surgeries, physiotherapy, chiropractic, and all other services which the attending physical and medical provider deem essential for the treatment and rehabilitation. These treatments and services are limited to $50,000 and have a two-year limitation period (the period in which a claim can be made).

For a “minor injury” treated in accordance with the Diagnostic and Treatment Protocols Regulation, the insurance company must pay for up to 21 medical, physical therapy, chiropractic, and adjunct therapy visits in the 90 days following the accident, depending on the injury and treatment recommended by the plaintiff’s healthcare provider. Injured people may also be entitled to additional dental, occupational therapy, and psychological counseling treatments. However, if treatment is needed more than 90 days after the accident, that coverage will need to be approved by the insurance company.

For a “serious injury,” medical benefits are available up to two years following the accident, up to a maximum of $50,000 per person involved in the accident. These medical benefits are also available for plaintiffs choosing not to be diagnosed and treated in accordance with the Diagnostic and Treatment Protocols Regulation.

Whether injuries are minor or serious is determined in consultation with a doctor and with reference to Alberta’s Minor Injury Regulation.

Any treatment should be covered that a doctor concludes is medically necessary. Expenses covered by Section B normally include things like:

• Massage therapy (up to $350 maximum)
• Acupuncture (up to $350 maximum)
• Chiropractic (up to $1,000 maximum)

Disability Benefits are available to those disabled due to an MVA who were employed at the time of the accident and were not able to perform all of their employment duties within 60 days from the accident date. This benefit has a seven-day waiting period and any payments for loss of earnings received from all other sources is accounted for in the calculation. The benefit pays 80% of gross earnings up $600 per week.

The Diagnostic Treatment Protocol Regulation (DTPR) applies if the patient wishes to be diagnosed and treated following the protocols for a sprain, strain, or Whiplash and Associate Disorder (WAD) (cervical, thoracic, lumbar, and lumbosacral) injury caused by an MVA.

• 10 visits maximum – if a person is diagnosed with a sprain/strain 1 or 2 or WAD 1 injury
• 21 visits maximum – if a person is diagnosed with a sprain/strain 3 or WAD 2 injury

Under Alberta law, there are two types of pain and suffering that can be compensated for: general damages and special damages. General damages refer to the non-economic losses suffered, such as physical pain and suffering, mental anguish, and emotional distress. Special damages refer to the economic losses suffered, such as medical bills, lost wages, and property damage. In Alberta, the average compensation for pain and suffering is approximately $50,000 to $60,000. However, this amount can vary significantly depending on the nature and severity of the injury. In some cases, the amount of compensation awarded may be much higher.

For more information click here.

Ontario

Statutory Accident Benefits (SABs) are mandatory in motor vehicle policies. People injured in MVAs may file claims to obtain necessary financial relief for various expenses and losses. Benefits include medical bills not covered by the Ontario Health Insurance Plan (OHIP), lost income, caregiver costs, and more.

When it comes to medical, rehabilitation, and attendant care benefits, a person will fall into one of three categories:

• Minor-injury guidelines
• Non-catastrophic injuries
• Catastrophic injuries

The combined mandatory minimum coverage is $3,500 for minor injuries, $65,000 for non-catastrophic injuries and $1 million for catastrophic injuries.

If a person cannot work because of an MVA, they may be eligible for weekly Income Replacement Benefits of 70% of their gross income up to $400 per week.

When someone does not qualify for Income Replacement Benefits, Non-Earner benefits are paid. If the injured person was at least 16 years old at the time of the accident and a full-time student or recent graduate without employment, they may be eligible for non-earner benefits. These benefits compensate injured people who are unable to engage in their activities of daily living and amount to $185 per week for the first 26 weeks (six months) of disability. If a non-earner’s disability continues past 104 weeks (two years), payments can increase to $320 per week under certain circumstances.

Lost educational expenses offer a maximum benefit of $15,000.

There can also be up to $100 a week for housekeeping expenses when the injured person needs to hire someone to perform these tasks.

Dependent care benefits can cover up to $75 per week for a person’s first dependent and $25 for each additional dependent but can only be claimed if a person was employed at the time of the accident and needs to pay for additional childcare expenses due to their injuries.

Attendant care benefits cover reasonable and necessary expenses that a plaintiff incurs in hiring an individual to assist them with self-care post-accident. Attendant Care covers:

• In-home care to the plaintiff by an attendant or personal aide;
• Long-term facility convalescent care.

The amount and duration of Attendant Care Benefits available depend upon the nature, severity, and extent of plaintiff injuries.

• Up to $3,000 per month for non-minor injuries, totaling $36,000 (to be paid for no more than 104 weeks from the date of the accident); and
• Up to $6,000 per month for catastrophic injuries, totaling no more than $1 million (with no time limit).

For more information click here.