Auto Insurance Claims

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AUTO INSURANCE COVERAGE IN ONTARIO

The issues about automobile insurance coverage are directly connected with the motor vehicle accidents and traffic tickets. That is why we decided to give you some useful and extended information about auto insurance: types of auto insurance, what insurance policy is, what is your liability, how your auto insurance rates are set, accident benefits coverage and more. We hope that this information will help you to better understand automobile insurance.

Auto Insurance – It’s the Law!

Ontario law requires that all motorists have auto insurance. Fines for vehicle owners, lessees and drivers who do not carry valid auto insurance can range from $5,000 to $50,000.

If you are found driving without valid auto insurance, you can have your driver’s licence suspended and your vehicle impounded.

If you are convicted of driving without valid auto insurance, your insurance company may consider you a “high-risk” driver and charge you higher premiums or refuse to sell you insurance altogether. If you are injured in an accident while driving or occupying an uninsured vehicle:

  • you may not be entitled to receive income replacement and/or non-earner benefits; and
  • you may not be allowed to sue the at-fault driver for compensation as a result of injuries received in the accident.

More importantly, if you are found to be at fault for an accident causing injury or death to another person, you may be held personally responsible for his/her medical costs and other losses.

Auto Insurance Policy

Your insurance company is responsible for providing you with the insurance coverage summarized on your Certificate of Automobile Insurance, and for which you pay a premium.

Certificate of Automobile Insurance:

  • lists the vehicles that are insured and the coverage purchased,
  • provides a description of how you were rated for the premiums charged, and
  • indicates the period during which you are covered by insurance

It is important that you read this certificate. You only have insurance coverage for a vehicle if your Certificate of Automobile Insurance shows a premium for that vehicle or shows that the coverage is provided at no cost.

What’s in a Standard Auto Insurance Policy?

If you own a vehicle in Ontario, you are required to, at the very least, purchase the following automobile insurance coverage:

  • Third-Party Liability Coverage: This section of your automobile insurance policy protects you if someone else is killed or injured, or their property is damaged. It will pay for claims as a result of lawsuits against you up to the limit of your coverage, and will pay the costs of settling the claims. By law you must carry a minimum of $200,000 in Third-Party Liability coverage
  • Statutory Accident Benefits Coverage: This section of your automobile insurance policy provides you with benefits if you are injured in an automobile accident, regardless of who caused the accident including supplementary medical, rehabilitation, attendant care, caregiver, non-earner and income replacement benefits
  • Direct Compensation – Property Damage (DC-PD) Coverage: This section of your automobile insurance policy covers damage to your vehicle or its contents, and for loss of use of your vehicle or its contents, to the extent that another person was at fault for the accident. It is called direct compensation because even though someone else causes the damage, you collect directly from your own insurer, instead of the person who caused the damage. Coverage under the DC-PD section of your automobile insurance policy only applies if the following conditions are met: 1) the accident took place in Ontario; 2) there was at least one other vehicle involved in the accident; and 3) at least one of the other vehicles is also insured by an insurance company that is licensed in Ontario or has signed a special agreement with FSCO to provide this coverage. If these conditions are not met, then you can make a claim on your optional Collision coverage (if you have it), whether or not you are at fault. If you don’t have Collision coverage, you may be able to pursue recovery from the at-fault driver to the extent you were not-at-fault for the accident.
  • Uninsured Automobile Coverage: Protects you and your family if you are injured or killed by a hit-and-run driver or by an uninsured motorist. It also covers damage to your vehicle caused by an identified uninsured driver.
  • Increased Liability and Accident Benefits Coverage: In addition to the mandatory minimum coverage that is required by law, you may purchase higher liability limits under your Third-Party Liability Coverage, as well as increased Accident Benefit Coverage. These options will allow you to customize your policy to better suit your needs.
  • Increased Third-Party Liability Coverage: While you are legally required to carry a minimum of $200,000, you may want to increase this coverage. The cost to increase your Third-Party Liability coverage to $1 million or $2 million is small in most cases.
  • Income Replacement Benefits: If you cannot work as the result of an automobile accident, you may be eligible for basic weekly income replacement benefits of 70 per cent of your gross income up to $400. If this is not enough to cover your current after tax income level, you may want to consider buying optional income replacement benefits to increase your maximum weekly protection to $600, $800 or $1,000. When considering the amount of coverage you will need, keep in mind you are required to first claim wage loss benefits from a disability plan you have purchased or workplace benefits that you have access to.
  • Medical, Rehabilitation and Attendant Care Benefits: The standard maximum amount for medical and rehabilitation expenses, such as physiotherapy, chiropractic treatment, dental expenses, etc., is $50,000. If you are catastrophically injured, the standard maximum is $1,000,000. The standard maximum for attendant care is $36,000. If you are catastrophically injured, the standard maximum is $1,000,000. You can buy optional benefits which will cover up to $100,000 or $1,100,000 in medical and rehabilitation expenses and $72,000 or $1,072,000 in attendant care expenses, and up to $3,000,000 in combined medical, rehabilitation and attendant care expenses for catastrophic injuries. Keep in mind that many health care expenses are not covered by OHIP, or only partially covered, including physiotherapy and chiropractic treatment, mobility devices (crutches, wheelchairs), modifications to your home and car that you may require, and other specialized goods and services. Minor injuries may only require several thousand dollars in treatment. The most serious injuries (brain injuries, amputations) are permanent and may require hundreds of thousands of dollars in specialized goods and services on an ongoing basis. You may need the services of an attendant 24 hours a day. Review any extended health care plan you and your spouse have access to through work to help you decide how much coverage you require.
  • Caregiver Benefits: If you are providing care full-time to dependants and can no longer provide that care as the result of an automobile accident, you may be eligible for caregiver benefits if you need to hire someone to care for your dependants. The maximum amount for caregiver benefits is $250 per week for one dependant, plus $50 per week for each additional dependant. The standard coverage is only available to those who are catastrophically injured in an auto accident. You can extend coverage to all injuries by purchasing the optional benefit. If you have children you need to consider who will look after them if you are injured in an auto accident.
  • Housekeeping and Home Maintenance Expenses: If you are unable to perform your usual housekeeping or home maintenance duties, these corresponding benefits pay for someone to perform the duties. The maximum benefit payment is $100 per week. The standard coverage is only available to those who are catastrophically injured in an auto accident. You can extend coverage to all injuries by purchasing the optional benefit. If you normally do the cleaning and maintenance of your home, you need to consider who will look after these things if you are injured in an auto accident.
  • Dependant Care Benefits: This optional benefit can only be claimed if you were employed at the time of the accident, are not receiving a caregiver benefit, and have to pay for additional childcare expenses as a result of the accident. Optional dependant care benefits cover up to $75 per week for the first dependant and $25 for each additional dependant.
  • Death and Funeral Benefits: In the event that you die as a result of an auto accident, the standard amount which will be paid is $25,000 to your eligible spouse, $10,000 to each dependant, and a maximum of $6,000 for funeral expenses. If you buy optional benefits, you can increase these amounts to $50,000 to your eligible spouse, $20,000 to each dependant, and $8,000 for funeral expenses.

Extra Coverage for Loss or Damage to Your Vehicle

In addition to the standard policy coverages you may also buy extra coverage for loss or damage to your vehicle including:

  • Specified Perils Coverage: This coverage pays for losses caused by one of the following perils: fire; theft or attempted theft; lightning, windstorm, hail, or rising water; earthquake; explosion; riot or civil disturbance; falling or forced landing of an aircraft or parts of an aircraft; or the stranding, sinking, burning, derailment or collision of any kind of transport in, or upon which an insured vehicle is being carried on land or water.
  • Comprehensive Coverage: This coverage pays for losses, other than those covered by Collision or Upset, including perils listed under Specified Perils, falling or flying objects, missiles and vandalism.
  • Collision or Upset Coverage: This coverage pays for losses caused when an insured vehicle is involved in a collision with another object, including another vehicle, or rolls over. “Object” includes: another vehicle or a trailer that is attached to the vehicle that is covered by your insurance policy; the surface of the ground, and any object in or on the ground.
  • All Perils Coverage: This combines Collision or Upset and Comprehensive coverages. In addition, it covers loss or damage caused if a person who lives in your home steals the vehicle that is covered by your insurance policy. All Perils also covers you if an employee who drives or uses, services or repairs that vehicle, steals it. For example, if you take your vehicle to a garage for repairs and an employee involved in the repair of your vehicle steals it, All Perils would cover you.

How the Auto Insurance Rates are Set

Your auto insurance rates are determined by a combination of factors including:

  1. Your Personal Profile
  2. The Amount of Coverage You Purchase
  3. Your Deductible
  4. The Insurance Company You Choose

1) Your Personal Profile

  • The type of vehicle you drive: Many insurance companies’ rate makes and models of vehicles according to their actual claims experience, such as the cost of repairs, the rate of injury, and the likelihood that a particular vehicle may be stolen or involved in an accident. The Insurance Bureau of Canada (IBC) has a document called How Cars Measure Up. This document provides information on the claims experience of most models of passenger vehicles. To review or print the latest version of “How Cars Measure Up”, visit IBC’s website at: www.ibc.ca.
  • Your driving record: The premium you pay also depends on your driving record. This includes accidents where you are more than 25 per cent at-fault1, the length of time you have been licensed to drive, whether or not you have taken a driver-training course that your insurance company recognizes, and driving convictions (such as: speeding and impaired or careless driving). Generally, your first minor conviction will have little or no impact on your rates. But if you have had a second minor conviction in the last three years, it will most likely affect your premium. If you have had accidents where you are more than 25 per cent at-fault over the last six years2, or a number of minor driving convictions or even one major or serious conviction over the last three years, your premium will be higher. Likewise, the better your driving record, the lower your premium will be.
  • How much you drive: Your auto insurance premium will also be affected by how much you drive. This is because the more time you spend on the road, the higher the chances of becoming involved in an accident. In urban areas, driving to work may include driving to a subway, bus, or train station. If you live close to work, you will probably have a lower premium than someone who lives far from work or who needs to use his or her vehicle for business.
  • Where you live: Auto insurance rates are generally higher in larger urban centres. This is because there are a greater number of vehicles on the road, and the chances of getting into an accident are higher. Also, more vehicles are stolen in urban areas.
  • Your age: In general, mature drivers have fewer accidents than younger drivers, particularly teenagers. Drivers who are 25 years of age and over can generally buy insurance at a considerably lower cost than younger drivers.

Only those accidents occurring on or after September 1, 2010 where you were more than 25% at fault can be used in rating. Any at fault accident that occurred before September 1, 2010 can still be used in rating.

2. The Amount of Coverage You Purchase

Many people buy additional protection beyond the mandatory coverage. For example, if you buy optional Collision Coverage, which protects you for damage to your vehicle regardless of who caused the accident, or Comprehensive Coverage, which protects you against theft, vandalism, hail, or explosion, your vehicle will, be covered against any such incidences, but you will pay more.

There are also other options, such as increasing your Third-Party Liability protection or increasing your Standard Accident Benefits Coverage.  These options give you more choice and flexibility over your coverage that will allow you to customize your policy to better suit your needs. All of these optional coverages will have an effect on the cost of your policy.

3. Your Deductible

Your deductible is the portion of a loss that you are required to pay. Your deductible can vary, depending on the type of coverage you have and the percentage of fault you are assigned in the event of an accident. There are deductibles for Collision or Upset, Comprehensive, All Perils, and Specified Perils Coverage.

You can also pay a lower premium by having a deductible on Direct Compensation-Property Damage (DC-PD) Coverage or raising the deductible on the other coverage. For example, by having a higher deductible of $500, instead of $300, on Comprehensive Coverage, you can save about 10 per cent off your Comprehensive premium. These savings are due to the fact that higher deductibles mean you pay more towards the cost of repairing your vehicle, while your insurance company pays less toward the total cost of repair. As a result, your premium will be lower. If you’d rather have lower deductibles, you may be able to do so if you meet certain conditions and if your company offers them, but your premium will be higher. (Recognize, however, that since Collision or Upset and Comprehensive are both optional coverages, your insurance company may obligate you to carry higher deductibles if you have had a lot of prior claims.)

4. The Insurance Company You Choose

As mentioned above, auto insurance premiums for the exact same coverage can vary substantially from insurance company to insurance company. Why? Financial factors unique to each insurance company will contribute to the amount each company will charge you for auto insurance. This is why it is important to shop around!

Insurance works according to a “pooling” concept. You are one member of the risk group in the company you select as your insurer. Your company charges premiums based on the claims experience of the entire group. If an insurance company’s claims experience for a particular risk group is significantly higher than another insurance company’s, its insurance premiums will be higher.

High Risk Drivers

Although an individual insurance company may refuse to sell you auto insurance if its approved underwriting rules determine you to be a “high risk,” the insurance industry as a whole cannot refuse to sell you basic insurance.

High-risk drivers are those drivers who have had a number of convictions or at-fault accidents, had policies cancelled because they haven’t paid their premiums, or have other risk-related characteristics.

The Facility Association, an insurance pool that all auto insurance companies belong to, is an insurer of last resort, which makes auto insurance available to high-risk drivers who are unable to find automobile insurance in the regular market. As well, there are a number of “non-standard” insurers who specialize in insuring high-risk drivers.

Tips for Saving Money on Auto Insurance

The following tips may help you save money on your auto insurance:

  • Build a good driving history free of accidents and convictions. This means driving carefully and obeying the rules of the road. Wear your seat belt and don’t use your cell phone while driving. Don’t drink and drive.
  • Be a comparison shopper. Talk to your friends and neighbours. Make some phone calls and check websites for on-line quotes. Compare rates. Different companies price policies differently. Do your shopping well in advance of when your current policy expires.
  • Don’t pay for coverage you don’t need. For example, it may not be cost effective to have Collision or Upset and/or Comprehensive Coverages on a vehicle that is worth less than $1,000, because any claim you make would not substantially exceed your deductible or the annual premium.
  • Consider higher deductibles. This means you’ll contribute more toward the loss if you have an accident, but it will also mean a lower premium. For example, a zero-dollar deductible usually applies to your DC-PD Coverage. However, you may be able to lower your auto insurance premium by increasing this deductible.
  • Make sure you always pay your premium on time. If you pay your premium by cheque or through automatic withdrawals from your bank account, make sure you always have enough money to cover your payment. If your insurance company is unable to withdraw your payment because you don’t have enough money in the account, it could result in the cancellation of your auto insurance policy. If your policy is cancelled for non-payment of premium more than twice, and you have to purchase auto insurance all over again, many companies may consider you a higher risk, and you could pay much more for your auto insurance. Also, if you’ve had your insurance policy cancelled more than once over the past three years because you failed to pay your premium, insurance companies are not required to offer the option of monthly premium payments.
  • Choose the type of vehicle you drive wisely. For example, if you buy a vehicle with a high theft rate, your premium will be higher. Choose a vehicle with good security features.
  • · Take advantage of discounts which may be available to you.
  • Make sure you tell your broker, agent, or insurance company about any changes to your policy (e.g., different drivers, different use of the vehicle). In some cases, your premium will drop.
  • Finally, don’t switch insurance companies mid way through the policy. Wait until renewal time to avoid penalties for cancellation.

Insurance Fraud Is a Crime!

Insurance fraud costs all of us in the form of higher auto insurance premiums. It is an offence under the federal Criminal Code for anyone, by deceit, falsehood, or other dishonest act, to defraud or to attempt to defraud an insurance company. If you are caught committing or attempting to commit insurance fraud:

  • Your claim will be denied.
  • Your insurance policy may be cancelled outright.
  • You may pay higher premiums in the future.
  • You may be denied insurance in the future.
  • More importantly, the offence is punishable, on conviction, by a maximum of 10 years’ imprisonment for cases involving an amount over $5,000 or otherwise a maximum of 2 years’ imprisonment.

Common types of fraud or attempted fraud may include:

  • lying about the way a loss occurred,
  • filing fraudulent automobile accident or damage claims,
  • including previously existing damage to a vehicle when submitting a claim,
  • withholding information about past accidents, traffic convictions, claims, policy cancellations or non-renewals, other insurance in force, and medical and disability history, and
  • receiving payments for treatments not received

Did You Know That …

  • It is not only the driver but also the owner of the vehicle who is liable when an accident is caused with his or her vehicle. This puts a heavy onus on owners to ensure that they give only competent drivers permission to operate their vehicle!
  • Your auto insurance rates are based on the information you have given to your broker, agent, or insurance company. An insurance company has the right to cancel your policy if the information you have given is not correct or complete.
  • If you have a lot of comprehensive claims (e.g., repeat broken windshield claims), your insurance company may require you to have a higher deductible or may refuse to sell you Comprehensive Coverage at all.
  • If you want to change insurance companies and cancel your existing policy before it expires, you may have to pay a penalty. You may instead want to have the new policy start once your existing policy expires.
  • You should receive your policy renewal from your insurance company approximately 30 days before it expires. This allows you to change your policy, examine policy changes, or shop around.
  • If you don’t want to renew your policy, you should notify your broker, agent, or insurance company immediately. Don’t just stop making payments: that will result in cancellation of your policy because of non-payment and possibly put you in a higher risk category.
  • Your insurer can cancel your policy for non-payment of premiums, so long as it follows certain procedures. As required by the Insurance Act, the insurer must give you 15 days’ notice of termination by registered mail or five days written notice of termination if it’s personally delivered. If you pay the outstanding premium before the end of the notice period, the insurer may, but is not required to, keep the policy in force. If the insurer does not receive your payment before the end of the notice period, your policy will be cancelled for non-payment.
  • If there is a lapse in your coverage due to cancellation of your policy because of non-payment of premiums, insurance companies may then charge you higher premiums for a future policy.
  • Your auto insurance policy requires that any accident involving injury or property damage, be reported to your insurance company within seven days, regardless of who is at fault. If you are unable to report within seven days, you must report it as soon as possible after the accident.

MAKING A CLAIM FOR PROPERTY DAMAGE

If you have sustained property damage as a result of a motor vehicle accident, you may make a claim to the Motor Vehicle Accident Claims Fund, provided the owner and driver of the at-fault vehicle are identified. You may not make a claim to the Motor Vehicle Accident Claims Fund for damages to a motor vehicle, uninsured or otherwise. Claims for property damage are subject to a $100 deductible. Any claim in which the amount recoverable from the Fund exceeds $3000.00 requires legal action.

To make a claim for property damage, you must complete an Application. The application must be sent to the Motor Vehicle Accident Claims Fund with the following substantiating documentation:

  • Police Officer Report
  • Damage estimates and/or repair invoice
  • Consent and Notification forms (property damage claims only). These forms need only be signed and returned if the Application is being made on behalf of a private individual

For more information about making a claim for property damage and the Consent and Notification form, please contact CP Paralegal Solutions.

AUTO INSURANCE COMPLAINTS

Ontario Automobile Policy as of September 1, 2010

The Ontario Automobile Policy (effective September 1, 2010) sets out the rights and obligations of insured persons and insurance companies related to automobile insurance coverage, and the terms and conditions of that coverage. The mandatory coverage is liability, accident benefits, direct compensation – property damage, and uninsured automobile. Optional coverage includes increased liability as well as collision and comprehensive coverage for your automobile and its contents.

The Ontario government introduced changes to the auto insurance system intended to provide greater price stability, and give drivers more control over the amount of coverage and price they pay for auto insurance.

As a result, some coverage under the Ontario Auto Insurance policy has been altered. Drivers are now able to:

  • Choose the insurance coverage that best meets their protection needs and budgets.
  • Customize their level of income replacement, medical, rehabilitation, attendant care, caregiver, housekeeping, death benefits and home maintenance coverage; and
  • Better integrate their auto insurance with private disability insurance coverage, or individual or group health insurance coverage

In Ontario, automobile insurance is regulated by the Financial Services Commission of Ontario, a regulatory agency of the Ministry of Finance. Every person who owns a car is required to have insurance for the vehicle.

The Financial Services Commission of Ontario (FSCO)

The Financial Services Commission of Ontario (FSCO) is responsible for regulating the insurance industry in Ontario. If you have a complaint about an insurance company, agent or adjuster, you have to go to FSCO to resolve the problem. One of the resources available to consumers who have an insurance complaint is an independent OmbudService whose role is to assist consumers in resolving insurance complaints. The services are free of charge and you do not need a lawyer. However, it is a good idea to talk to us first or consider seeking legal advice somewhere else BEFORE making a complaint.

In addition, some insurance disputes may involve a possible breach of the Insurance Act and/or regulations. If you think there is a possible violation of the law, you can make a complaint directly to FSCO, who will review the allegations. The focus of FSCO’s review is to determine whether the law has been violated and whether there is a case for taking enforcement action against the insurance company, agent or adjuster.  There is a form you can use to make a complaint to FSCO.

The Insurance Complaint Process

There are some recommended steps you can take when you have a complaint:

Step 1 – Contact your insurance company to discuss your complaint.

Each insurance company has a process for dealing with complaints and has a complaint officer who is responsible for overseeing the insurer’s complaint process. You can get the name and contact information of your insurance company’s complaint officer by:

  • asking your insurance representative,
  • referring to FSCO’s list of company complaint officers, or
  • contacting FSCO

Often a complaint can be resolved by discussing it with the insurer’s complaint officer.

Step 2 – If the insurance company is unable to resolve your complaint to your satisfaction, ask the company to provide you with its final position in writing

Your insurance company complaint officer should ensure that you receive a letter that states the company’s final position and provide you the contact information of the independent OmbudService that can review your complaint.

Step 3 – Contact the appropriate Ombudsman

Once you have the insurer’s final position letter, you may wish to contact the appropriate OmbudService to get assistance in resolving your complaint. Once the OmbudService has all of the information it needs, the OmbudService can provide dispute resolution processes such as mediation and adjudication.

CP Paralegal Solutions can give you an advice on all auto insurance claims matters. We are licensed by the Law Society of Upper Canada and can ensure you are in compliance with all appropriate rules.