When a person is injured in a motor vehicle accident, the Statutory Accident Benefit Schedule requires the automobile insurer to pay for non-professional health care services (such as personal support and homemaking services, attendant care services, and community support services). These services may be provided at home or in community settings such as supportive housing units, long-term care homes and complex continuing care hospitals.

Typically, non-professional services can be arranged or provided through local Community Care Access Centres (CCACs), long-term care homes or other third-party agencies funded by the Ministry of Health and Long-Term Care (ministry). Clients who may require these services include those with serious or catastrophic physical injuries and brain injuries.

The Ministry of Health and Long-Term Care pays for:

• Medical costs (all physician services)

• Hospital services

• Mental health facilities

• Air ambulance

• Several professional in-home health services such as nursing, occupational therapy, physiotherapy, speech-language pathology, social work and nutritional services are provided in a range of settings including the home, school or community

• Any other ministry-funded services not covered under the Long-Term Care Act, 1994

Automobile insurers should arrange non-professional health services for their clients and pay the service provider directly.

It is only after statutory accident benefits have been exhausted, or the level of service required exceeds specified maximums, that the ministry may consider funding these services, subject to assessment of the client and applicable ministry limits.

The ministry's subrogation unit is responsible for monitoring compliance of payment responsibility for persons injured in motor vehicle accidents and who require health services.

Automobile Insurers pay for:

• Community Support Services, such as; Meals and transportation:

• Caregiver support

• Home maintenance and repair

• Social or recreational services

• Attendant Care/Personal Support/Homemaking Services, such as; Assistance with activities of daily living:

• Assistance with personal hygiene

• House cleaning, laundry

• Preparing meals

 Note, if you have been in an Auto Accident regardless of whether you are the policyholder and owner of the vehicle or not you should consult with a Lawyer who is best qualified to advise and ensure that you receive any eligible benefits and compensation that you are entitled to. 

Here’s How We Can Help

Here at K. A. Drake Seniors Assisted Living Inc. if our client’s injuries are due to motor vehicle accidents, we can assist by knowing which organization should be paying for required health care services.

We can help by :

• Knowing which health care services the Ministry of Health and Long-Term Care pays for, and which ones are paid directly by the automobile insurer

• Ensuring that you as our client claim his or her automobile insurer

• Verifying that you as our client contacted the automobile insurer for the provision and payment of attendant care, personal support and homemaking services

If you have questions about health services and motor vehicle accidents or would like more information please call: 613-548-6663 

Read more about Auto Insurance Coverage

https://www.health.gov.on.ca/en/public/publications/ohip/motorvehicle.aspx

Call ServiceOntario, Infoline at:
1-866-532-3161 (Toll-free in Ontario only)
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282
Hours of operation: 8:30 am - 5:00 pm

This information is not intended as legal advice. It is based on Legislation in the Insurance Act including amendments made through Bill 59 in November 1996. The contents are current as of today's date but are subject to change. Readers should satisfy themselves as to the currency/accuracy of the material at any particular time.

Catalogue Number 014389 / 014390

This is not a legal document and does not in any way modify or replace your auto insurance policy. For more detailed information, make sure to read your Ontario Auto Policy.

If you do not have a copy of your Ontario Auto Policy, you may ask your insurance agent, broker, or company representative for a copy, or download a copy of the standard policy