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What Does OHIP and Other Types of Insurance Have to Do with Your Ontario Automobile Accident?

After drivers are injured in automobile accidents in Ontario, they may be confused about who they submit their medical bills to and how they may be compensated for medical expenses not covered by insurance.

The first person injured drivers think should cover their medical expenses is the at-fault driver’s auto insurance company. Unfortunately, this is not true. The at-fault driver’s auto insurance company is not even part of the process. Rather, it is the injured driver’s own insurance coverage and policies (whether through OHIP, the driver’s private supplemental disability insurer or their own auto insurance company) that come into play.

There is a priority of payments for health care services after an auto accident, and this article will discuss how the priority of payments works.

1. Ministry Programs

The first level of coverage is from ministry programs, such as OHIP. Therefore, OHIP will pay for covered medical expenses related to the injured driver’s car accident.

2. Injured Driver’s Private Insurance Plans

The second level of coverage is the injured driver’s private supplementary health and disability insurer and private plans from the driver’s employer. Thus, medical expenses not covered by OHIP will then be submitted to the injured driver’s private insurance plan.

3. Auto Insurance Company

Medical expenses not covered by OHIP and/or the injured driver’s private insurance plans will then be covered by the driver’s auto insurance company through Statutory Accident Benefits.

How the Priority of Payments Works After a Hypothetical Auto Accident in Kingston, Ontario

Driver A was seriously injured in a car accident in Kingston. Driver B was texting while he was driving and caused the head-on collision with Driver’s A vehicle. Driver A shattered his knee cap. He needed knee surgery and will need rehabilitation services after his surgery.

Driver A’s medical claim from his medical treatments must be submitted to OHIP first. If the driver has extended health insurance through his employer, the claim is then submitted to the private insurance company.

If the medical treatments the injured driver receives are not covered by OHIP or extended health insurance, then the driver may receive medical and rehabilitation benefits (one type of Statutory Accident Benefits) from his own auto insurance company.

The amount of medical and rehabilitation accident benefits the driver receives is dependent on the extent of his injuries.

Per Ontario law, if a driver sustains minor injuries, he is eligible to receive $3,500 in medical and rehabilitation benefits. If the driver sustains a non-minor injury, then he is eligible to receive up to $50,000 in medical and rehabilitation benefits. If the driver sustains catastrophic injuries, he is eligible to receive up to $1,000,000 in medical and rehabilitation benefits.

Many injured drivers may feel that it is unfair they have to use their own private health insurance or employer’s insurance to cover their medical expenses resulting from an accident that was no fault of their own. What if they need to use those benefits in an accident later, such as a slip and fall accident? Injured drivers have every right to feel this way. Unfortunately, this is the law.

Having an experienced car accident lawyer who has the expertise in Statutory Accident Benefits on your side is crucial. Experienced car accident lawyers can help injured drivers obtain maximum accident benefits they are entitled to and also help them file a lawsuit (tort claim) against the at-fault driver to obtain damages not recoverable through accident benefits such as pain and suffering.

Help After A Kingston, Ontario Car Accident

If you were injured in a car accident and would like to explore your legal options, call the lawyers at Bergeron Clifford to schedule a FREE consultation. 1-866-384-5886

Contact Bergeron | Clifford LLP

Let us help you if you have been injured anywhere in Eastern Ontario. Contact us at 866-384-5886 or fill out our online form. We can meet at any of our office locations, including Kingston, Ottawa, Whitby, Carleton Place, Perth or wherever is most convenient for you.

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