When Do Income Replacement Benefits Start? – A Primer on Income Replacement Benefits

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Written By: Michael Warfe and Brandon Pedersen, Student-at-Law

When Do Income Replacement Benefits Start? | McLeish Orlando Personal Injury Lawyers

If you are involved in a motor vehicle collision, you are likely eligible for no-fault benefits from your insurance provider. There are a number of benefits you may be eligible to collect as a result of your injury.

How do I receive benefits?

You must fill out an application and submit it to your insurer. Before paying any benefits to an insured, an insurer will require a Disability Certificate (OCF-3) and potentially additional medical documentation evidencing the impairment that was caused by the accident.

If you are unable to return to work as a result of your injury, one of the benefits you may receive from your insurer is the income replacement benefit (“IRBs”).

What are Income Replacement Benefits?

Income Replacement Benefits provide coverage for a regular weekly income and pays 70% of your gross income up to a maximum of $400 per week.[1]

Am I eligible for IRBs?

Income Replacement Benefits are payable to those who sustain an impairment as a result of an accident and the accident is impacting upon their ability to work.

Pre-conditions to eligibility

An insured may be eligible for IRBs if they were employed or self-employed at the time of the accident. For insured’s in this category, your insurer will require an Employer’s Confirmation Form (OCF-2), which outlines the essential tasks of the insured’s employment (or self-employment), as well as details regarding the insured’s compensation. The OCF-2 will assist the insurer in quantifying the proper amount of IRBs to be paid.

Alternatively, an insured is eligible if:

  • They were not employed at the time of the accident, but were employed for at least 26 of the 52 weeks prior to the accident or were receiving benefits under the Employment Insurance Act (Canada) at the time of the accident, and
  • Were at least 16 years old, or were excused from attending school under the Education Act, at the time of the accident.[2]

“Substantial Inability”

For the first 104 weeks of disability, IRBs are payable while an insured person suffers a “substantial inability to perform the essential tasks of his or her employment or self-employment.”[3] This means that the insured person’s impairments must be severe enough that they cannot work or cannot work in the same way they did before the accident. The two questions that insurers consider are, “what were the essential tasks of the insured’s pre-accident employment?” and, “is the insured substantially prevented from fulfilling those tasks?” The answers to these questions are fact-specific, demonstrating the importance of submitting a properly completed Employer’s Confirmation Form (OCF-2) and Disability Certificate (OCF-3) as part of an application for accident benefits.

“Complete Inability”

After the first 104 weeks of disability, the insurer is not required to pay IRBs unless, “as a result of the accident, the insured person is suffering a complete inability to engage in any employment or self-employment for which he or she is reasonably suited by education, training or experience.”[4] Essentially, this means that the insured person’s impairments must be severe enough that they cannot work in their employment or one similar to it.

When do Income Replacement Benefits start?

If eligible, an insurer will pay an income replacement benefit beginning seven days after the accident.[5]

It is critical to complete an application as soon as practically possible following an accident in order to ensure you receive compensation to replace the loss of income sustained from missing time from work.

Applying for benefits or dealing with an insurance provider can be an onerous task. Due to the complexity of the Insurance Act and accompanying regulations, contact the experienced lawyers at McLeish Orlando LLP to help guide you through the process.

 

[1] O. Reg. 34/10: Statutory Accident Benefits Schedule – Effective September 1, 2010, under the Insurance Act, R.S.O. 1990, c. I.8, s. 7 [SABS].

[2] SABs, s. 5.

[3] SABS, s. 6(1).

[4] SABS, s. 6(2)(b).

[5] SABS, s. 6(2)(a).

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