Housekeeping and Home Maintenance Benefits – What you need to know about your Insurance Policy Accident Benefits if you have been involved in a motor vehicle collision
Many individuals who have suffered injuries as a result of a motor vehicle accident in Ontario have come to realize that their injuries have affected their ability to carry-on with housekeeping and home maintenance in the same manner which they were accustomed to before their car accident.
Under the current Ontario Insurance Act, Statutory Accident Benefits Schedule, an accident victim is entitled to claim assistance from their own accident insurer if a health care provider confirms that they are unable to substantially perform the housekeeping and home maintenance services they normally performed before the accident. In this situation, an insurer shall pay up to $100 per week for reasonable and necessary additional expenses incurred by or on behalf of an insured person. These benefits were available to insured persons for 2 years from the date of their automobile accident.
However, this is all about to change on September 1, 2010. The new Ontario Regulation 34/10 made under the Insurance Act will eliminate this entitlement to accident victims unless the accident victim is deemed catastrophic. Even those persons deemed catastrophic will no longer be able to claim for incurred housekeeping and home maintenance expenses by another person (ie: family member or friend, etc…) unless the person who provided the housekeeping and/or home maintenance did so in the course of his/her regular occupation, or sustained an economic loss as a result of providing the goods or services to the insured person.
The new legislation defines catastrophic impairment caused by an accident to include:
(2) (a) paraplegia or quadriplegia;
(b) the amputation of an arm or leg or another impairment causing the total and permanent loss of use of an arm or a leg;
(c) the total loss of vision in both eyes;
(d) subject to subsection (4), brain impairment that results in,
(i) a score of 9 or less on the Glasgow Coma Scale, as published in Jennett, B. and Teasdale, G., Management of Head Injuries, Contemporary Neurology Series, Volume 20, F.A. Davis Company, Philadelphia, 1981, according to a test administered within a reasonable period of time after the accident by a person trained for that purpose, or
(ii) a score of 2 (vegetative) or 3 (severe disability) on the Glasgow Outcome Scale, as published in Jennett, B. and Bond, M., Assessment of Outcome After Severe Brain Damage, Lancet i:480, 1975, according to a test administered more than six months after the accident by a person trained for that purpose;
(e) subject to subsections (4), (5) and (6), an impairment or combination of impairments that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in 55 per cent or more impairment of the whole person; or
(f) subject to subsections (4), (5) and (6), an impairment that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in a class 4 impairment (marked impairment) or class 5 impairment (extreme impairment) due to mental or behavioural disorder.
(3) Subsection (4) applies if an insured person is under the age of 16 years at the time of the accident and none of the Glasgow Coma Scale, the Glasgow Outcome Scale or the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, referred to in clause (2) (d), (e) or (f) can be applied by reason of the age of the insured person.
(4) For the purposes of clauses (2) (d), (e) and (f), an impairment sustained in an accident by an insured person described in subsection (3) that can reasonably be believed to be a catastrophic impairment shall be deemed to be the impairment that is most analogous to the impairment referred to in clause (2) (d), (e) or (f), after taking into consideration the developmental implications of the impairment.
(5) Clauses (2) (e) and (f) do not apply in respect of an insured person who sustains an impairment as a result of an accident unless,
(a) in the case of an impairment that includes a brain impairment, a physician states in writing that the insured person’s condition is unlikely to cease to be a catastrophic impairment;
(b) in the case of an impairment that is only a brain impairment, a neuropsychologist states in writing that the insured person’s condition is unlikely to cease to be a catastrophic impairment; or
(c) two years have elapsed since the accident.
(6) For the purpose of clauses (2) (e) and (f), an impairment that is sustained by an insured person but is not listed in the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993 is deemed to be the impairment that is listed in that document and that is most analogous to the impairment sustained by the insured person.
Commentary: What this means is that currently any insured person who is unable to substantially perform the housekeeping and home maintenance services they normally performed before the accident can receive up to $100 per week of housekeeping/home maintenance benefits for up to 2 years following their motor vehicle accident. The new legislation now eliminates these benefits totally with the exception of the most seriously injured persons (deemed to be catastrophic under the legislation).
For example, if a person were involved in a motor vehicle accident which caused them to sustain 2 broken arms that insured person would not be entitled to any housekeeping and home maintenance benefits.
If that same person were single or widowed living on their own with no family or friends to assist them with their housekeeping and home maintenance needs, the new legislation would not provide for any housekeeping or home maintenance benefits.
If that same person required their driveway to be shovelled so they could leave their home to go to physiotherapy treatment to assist them with rehabilitation for both broken arms, they would still not be entitled to housekeeping and/or home maintenance benefits.