What is & What Does No-Fault Insurance Cover?

No-fault insurance, also known as accident benefits coverage, is a type of car insurance that provides coverage for the insured driver and passengers, regardless of who is at fault in an accident. In Ontario, no-fault insurance is mandatory for all vehicle owners.

No-fault insurance covers a range of expenses, including:

1. Medical expenses: This includes reasonable and necessary medical expenses such as physiotherapy, chiropractic treatment, and rehabilitation costs.
2. Income replacement benefits: This covers lost income if the insured is unable to work as a result of the accident.
3. Caregiver benefits: If the insured is unable to care for a dependent due to the accident, caregiver benefits can help cover the cost of hiring someone to provide care.
4. Funeral expenses: In the event of a fatal accident, no-fault insurance can help cover funeral and burial expenses.
5. Death benefits: No-fault insurance provides compensation to the dependents of the deceased in the event of a fatal accident.

It is important to note that no-fault insurance does not cover damage to your vehicle or property, and liability insurance is still required to cover damages caused to others in an accident.

How Does No-fault Based Insurance Work

In Ontario, the no-fault insurance system is referred to as the Accident Benefits coverage, and it works similarly to other no-fault insurance systems. Here’s an example of how no-fault insurance works in Ontario:

Let’s say you are involved in a car accident in Ontario and you sustain injuries, and your car is damaged. Under the no-fault insurance system, you would first report the accident to your own insurance company, regardless of who was at fault for the accident.

Your insurance company would then provide you with benefits to help cover your medical expenses, rehabilitation costs, and other expenses related to your injuries, up to the limits of your policy. If you are unable to work due to your injuries, your insurance company may also provide income replacement benefits.

If you require additional benefits beyond what your policy covers, such as home modifications or attendant care, you may be able to apply for these benefits through the Ontario government’s Statutory Accident Benefits Schedule (SABS).

If you were not at fault for the accident, you may also be able to claim damages from the at-fault driver’s insurance company, such as compensation for pain and suffering or lost income. However, this is a separate process from the Accident Benefits coverage.

It’s important to note that the no-fault insurance system in Ontario does not cover damage to your vehicle or liability for damages caused to others in an accident. To cover these expenses, you must also have third-party liability insurance as part of your policy.

How Do Insurance Companies Assess Fault Percentage

In Ontario, insurance companies use a system called the Fault Determination Rules (FDR) to determine fault percentage in car accidents. The FDR is a set of regulations that outline the specific circumstances and factors that insurance adjusters must consider when determining fault percentage.

The FDR considers several factors when determining fault percentage, including:

1. The actions of each driver leading up to the accident
2. The speed and location of each vehicle
3. The road and weather conditions at the time of the accident
4. Any traffic signals or signs that were present at the scene
5. The statements of the drivers and witnesses involved in the accident
6. Any evidence, such as skid marks or damage to the vehicles, that can be used to reconstruct the accident

Based on the information gathered, insurance adjusters assign a percentage of fault to each driver involved in the accident. For example, one driver may be assigned 75% of the fault, while the other driver is assigned 25% of the fault. This determines how much each insurance company is responsible for covering the damages and injuries resulting from the accident.

If a driver disagrees with the fault percentage assigned by their insurance company, they can appeal the decision through the Ontario Insurance Ombudsman or through the court system. However, the appeals process can be lengthy and expensive, so it’s important to have a clear understanding of the FDR and how fault percentage is determined before deciding to appeal a decision.

What Are The Features Of No-Fault Based Insurance

Here are some of the key features of no-fault insurance:

1. No-Fault System: In a no-fault insurance system, each driver’s insurance company pays for their own damages and injuries resulting from an accident, regardless of who was at fault for the accident.
2. Simplified Claims Process: With no-fault insurance, the claims process is generally simpler and faster than in traditional fault-based systems. This is because drivers don’t have to wait for the other driver’s insurance company to investigate and determine fault before filing a claim.
3. Coverage for Medical Expenses: No-fault insurance typically covers medical expenses for drivers and passengers involved in an accident, including hospital bills, doctor visits, and rehabilitation costs.
4. Income Replacement Benefits: If an accident causes a driver to miss work due to injury, no-fault insurance may provide income replacement benefits to help cover lost wages.
5. Caregiver Benefits: If an accident causes a driver to become unable to care for a dependent, no-fault insurance may provide caregiver benefits to help cover the cost of hiring someone to provide care.
6. Limited Ability to Sue: In some cases, no-fault insurance may limit a driver’s ability to sue the other driver for damages resulting from an accident. This is typically limited to cases involving serious injury or death.
7. Different Laws in Different Jurisdictions: No-fault insurance laws vary by jurisdiction, so it’s important to understand the specific requirements and limitations of the law in your state or province.

Overall, no-fault insurance is designed to simplify and streamline the claims process, and provide drivers with quick access to benefits to cover their expenses after an accident.

What Can You Do If You Disagree With Claims Decision

If you disagree with a claims decision made by your insurance company, there are several steps you can take to try to resolve the issue:

1. Talk to your insurance adjuster: If you have questions or concerns about a claims decision, your first step should be to speak with your insurance adjuster. They can explain the reasons behind the decision and provide additional information about the claims process.
2. File a complaint with your insurance company: If you are still unsatisfied with the decision after speaking with your adjuster, you can file a formal complaint with your insurance company. Most insurance companies have a complaints process in place that allows customers to escalate their concerns.
3. Contact an ombudsman: If you are unable to resolve the issue with your insurance company, you can contact an ombudsman. An ombudsman is an independent third party who can help you resolve disputes with your insurance company. In Ontario, you can contact the Ontario Insurance Ombudsman.
4. Consider legal action: If you have exhausted all other options and still believe that the claims decision was unfair, you may want to consider taking legal action. This could involve hiring a lawyer to help you file a lawsuit or pursue arbitration.

Keep in mind that the process for disputing a claims decision can be complex and time-consuming. Before taking any action, it’s a good idea to review your insurance policy and understand your rights and obligations under the law.