Guide to Choosing Personal Auto Injury Insurance

Transcription

1 Guide to Choosing Personal Auto Injury Insurance 2018 basic auto insurance

2 This guide provides information about personal auto injury insurance available to all Saskatchewan residents. Motorcycle owners should also refer to SGI s motorcycle injury insurance page, for information about reduced No Fault injury coverage.

3 Table of contents What choice am I making?...1 Comparison of No Fault and Tort benefits...6 Frequently asked questions...8 Details of personal auto injury insurance No Fault Coverage...13 Details of personal auto injury insurance Tort Coverage...22 Other considerations...29 How do I change my personal auto injury insurance?...32 i

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5 What choice am I making? In Saskatchewan, all residents can choose the auto injury insurance coverage that s best for them. You have a choice between: No Fault Coverage Tort Coverage Why does Saskatchewan offer a choice in auto injury insurance? Before 1995, all Saskatchewan residents had tort insurance. In 1995, SGI introduced no fault insurance. Some people still wanted tort insurance. SGI responded to its customers in 2003 by offering all Saskatchewan residents the opportunity to choose the auto injury coverage that best meets their needs. Read on to learn the details about both coverages and how to make your choice. 1

6 What s No Fault Coverage? (page 13) No Fault Coverage provides a package of benefits that will cover the majority of your expenses if you re injured. If someone else is found responsible for the collision, No Fault Coverage allows you to sue for additional expenses. It doesn t allow you to sue for pain and suffering, except in very limited circumstances. No fault means you receive comprehensive benefits no matter who s responsible for the collision, but your right to sue for pain and suffering is very limited. All Saskatchewan residents have No Fault Coverage unless they file a declaration to choose Tort Coverage. That means, if you haven t filed a declaration choosing Tort Coverage, you re covered under No Fault Coverage. If you have Tort Coverage and wish to change to No Fault Coverage, you must file another declaration. You may switch injury coverages as often as you like, however, the coverage you have at the time of a collision will be the coverage you receive for any injuries you have. What s Tort Coverage? (page 22) Tort Coverage provides a basic package of benefits that will cover some of your expenses if you re injured. If someone else is found responsible for the collision, Tort Coverage allows you to sue for additional expenses and for pain and suffering. Tort means being held legally responsible for your actions. In auto injury coverage, it means you have the right to sue those responsible for your additional expenses and for pain and suffering. To choose Tort Coverage, you must file a declaration with SGI. Details on this process are found on page 32 of this booklet. 2

7 What basics do I need to know? All Saskatchewan residents can choose their injury coverage. Parents can choose their children s injury coverage. Even if you don t own a vehicle or drive, you can still choose an injury coverage. Both Tort and No Fault are quality insurance products and are equally priced. You can change your injury coverage at any time and as many times as you like at no cost. The coverage you have at the time of a collision will be the coverage you receive if you re injured. No matter what type of vehicle you drive or in what class it s registered, you can choose your injury coverage. All Saskatchewan residents have No Fault Coverage unless they choose Tort Coverage by filing a declaration form with SGI. For details on this process, please see page 32 of this booklet. If you wish to change the coverage you currently have, you must file a declaration. If you do nothing, you re covered under No Fault Coverage. What do I have to do? It s simple. If you haven t filed a declaration to choose Tort Coverage, you have No Fault Coverage. If you wish to change your injury coverage, simply visit any SGI motor licence issuer. Where can I get help? Call SGI toll free at TLK-2SGI ( ). Talk to your motor licence issuer. Visit 3

8 How does No Fault Coverage work? If you re injured in a motor vehicle collision, No Fault Coverage provides a comprehensive package of benefits that will meet most of the needs you ll have. You ll be able to sue those who caused the collision for your expenses in excess of the package of benefits; however, in most cases, all expenses are covered by the package of benefits. You can t sue for pain and suffering except in very limited circumstances. The expenses covered by the package of benefits will be paid as they arise. Medical professionals will work with your doctor or practitioner to develop a plan for your rehabilitation. The plan will be designed to help you recover from your injuries as fully and quickly as possible, so if you don t follow it, your recovery may be affected. If you don t participate in your rehabilitation plan, SGI may not pay your benefits. If you cause a collision, you can be sued by anyone injured for expenses above their package of benefits. You can t be sued for pain and suffering except in very limited circumstances. For more details on No Fault Coverage, see page 13. 4

9 How does Tort Coverage work? If you re injured in a motor vehicle collision, Tort Coverage provides a basic package of benefits that will meet some of the needs you ll have. You ll be able to sue those who caused the collision for your expenses in excess of the package of benefits. You ll also be able to sue those who caused the collision for pain and suffering, subject to a $5,000 deductible. The expenses covered by the package of benefits will be paid as they arise. In the vast majority of cases, your settlement for expenses in excess of the package of benefits and for pain and suffering will be reached through negotiations with the responsible person s insurance company. If a settlement can t be reached, you can take your case to court. You may not want to settle your claim until your injuries have healed enough to show how they re going to affect your life and the needs you ll have as a result. Depending on the circumstances, it can sometimes take months or years before a settlement can be made. With Tort Coverage, your authorized medical treatments will be paid for; however, it must be evident the treatments are beneficial to you. If you cause a collision, you can be sued by anyone injured for expenses above their package of benefits. You can also be sued for pain and suffering by those with Tort Coverage, and by those with No Fault coverage in very limited circumstances. For more details on Tort Coverage, see page 22. 5

10 Comparison of No Fault and Tort benefits No Fault Coverage (page 13) Saskatchewan residents with No Fault Coverage receive a higher level of defined benefits, regardless of the circumstances of the collision. They can sue for expenses not covered by the defined benefits. They cannot sue for pain and suffering except in very limited circumstances. For the majority of people, their claim settlement is made up entirely of the defined package of benefits. All Saskatchewan residents with No Fault Coverage are entitled to the benefits listed below. They can also sue for expenses in excess of these benefits. They can sue for pain and suffering in limited circumstances only. Defined package of benefits Income benefit (page 16) Medical and rehabilitation coverage (page 18) Permanent impairment payment (page 19) Death benefit (page 20) 90% of net income up to a maximum gross salary of $96,034 annually to age 65, if required after 180 days, non-earners including homemakers who continue to be disabled will receive at least minimum wage students will receive up to $20,531 for each school year missed substitute worker or caregiver benefit available up to $45,136 per year those under age 65 at the time of the collison and off work for at least two years also receive a lump-sum pension equal to 10% of total income benefit received up to $6,888,630 up to $197,405 except for those with catastrophic injuries up to $241,102 for those with catastrophic injuries spouse 45% of the deceased s net income to a maximum gross salary of $96,034 per year education and training allowance of up to $47,377 for dependent spouse dependent child 5% of the deceased s net income per dependent child or disabled adult $31,584 for loss of a child $15,792 per parent and non-dependent child for those with no spouse or dependants up to the maximum of $71,066 $10,331 funeral benefit 6

11 Tort Coverage (page 22) Saskatchewan residents with Tort Coverage receive a lower level of defined benefits, regardless of the circum stances of the collision. They can sue the responsible motorist for expenses not covered by the defined benefits. They can also sue for pain and suffering. For most injured people, the defined pack age of benefits makes up only part of their claim settlement. All Saskatchewan residents with Tort Coverage are entitled to the benefits listed below. They can also sue the responsible motorist for expenses in excess of these benefits, and for pain and suffering. Defined package of benefits Income benefit (page 25) Medical and rehabilitation coverage (page 27) Permanent impairment payment (page 27) Death benefit (page 28) up to $22,776 annually for a maximum of two years unless your injuries prevent you from working at all if totally disabled, benefit will be paid for life homemakers will also be paid up to $22,776 annually for a maximum two years those who do not qualify for the benefits above, but who are confined to a hospital, bed or wheelchair, will receive up to $11,388 for one year up to $26,960 except for those with catastrophic injuries up to $202,200 for those with catastrophic injuries up to $13,480 except for those with catastrophic injuries up to $175,240 for those with catastrophic injuries spouse 45% of the deceased s net income to a maximum gross salary of $96,034 per year dependent child 5% of the deceased s net income per dependent child $13,480 to estate of those with no spouse or dependants $6,740 funeral benefit 7

12 Frequently asked questions Do other Canadians have the same kinds of injury coverage choices? No other Canadian province offers residents a choice in auto injury coverage. All Canadian provinces offer their residents tort insurance with the exception of Manitoba and Quebec. These two provinces have no fault insurance. Do I have to pay to change the auto injury insurance I have? No. You can change your auto injury insurance coverage when you renew your vehicle or your driver s licence, or at any other time for no additional cost. Can I choose which kind of coverage I want after I ve been injured? No. Like any other insurance product, you must have coverage in place before you have a loss. So the coverage you have at the time of a collision will be the coverage you receive for any injuries you have. Can I be at fault with No Fault? Yes. No Fault Coverage is about auto injury insurance. Responsibility is still assessed in auto collisions and there are consequences, such as paying a deductible for your vehicle damage. If I m a passenger in a vehicle, am I covered by the driver s insurance, the vehicle s insurance or my own insurance? You receive the coverage you have chosen. It doesn t matter what coverage anyone else involved in the collision has. If I m responsible for a collision, does the coverage of the injured person make a difference? Yes. If they have Tort Coverage, they can sue for pain and suffering. If they have No Fault Coverage, they can only sue for pain and suffering under very limited circumstances. 8

13 What happens if I don t choose an auto injury insurance coverage? Will I have no insurance if I m injured in a collision? All Saskatchewan residents have No Fault Coverage unless they file a declaration form with SGI to choose Tort Coverage. So if you haven t filed a declaration and you re injured in an auto collision, you have No Fault Coverage. Do all members of a family have to carry the same auto injury insurance coverage? No. Each member can choose which coverage they want. What coverage do children have? A parent or legal guardian can choose which coverage best meets the needs of their children. If the parent hasn t filed a declaration for the child, the child has No Fault Coverage. Why is there such a difference in the package of benefits offered through Tort Coverage and No Fault Coverage? The basic idea behind No Fault Coverage is that it provides a comprehensive package of benefits to meet the majority of your needs if you re injured in an auto collision without you having to sue. The cost of the comprehensive package of benefits is offset by limiting your ability to sue for pain and suffering. The idea behind Tort Coverage is that its package of benefits will give you a basic level of protection if you re injured in an auto collision, but it allows you to sue the people responsible for your collision for additional losses, including for pain and suffering. Why didn t SGI simply add the right to sue for pain and suffering to No Fault Coverage? Benefit levels under No Fault Coverage are designed to cover virtually all of the needs of most Saskatchewan residents if they re injured in an auto collision. The cost of providing this comprehensive package of benefits in addition to allowing the ability to sue for pain and suffering would ve significantly increased the cost of licence plate insurance in Saskatchewan. 9

14 What s pain and suffering? A pain and suffering payment is intended to help compensate you if your quality of life has been affected by injuries you ve sustained in an auto collision. How does the deductible on pain and suffering work under Tort Coverage? You don t pay $5,000. The settlement you receive is simply reduced by $5,000 before it s paid to you. Why is there a $5,000 deductible on pain and suffering payments under Tort Coverage? The $5,000 deductible under Tort Coverage will lower costs for Tort Coverage, keeping premiums lower. If I select Tort Coverage, does that mean I have to go to court to sue for any expenses over the benefits I receive and for pain and suffering? No. In most cases, your settlement will be negotiated between the responsible party s insurance company and you or your representative. Only when a negotiated settlement can t be reached between the parties is the matter referred to the court system for a decision. I have No Fault Coverage. Can I be sued? If you injure someone with either Tort or No Fault Coverage, you can be sued for any expenses not covered by their package of benefits. You can t be sued for pain and suffering, except in very limited circumstances. The $200,000 liability coverage provided under your licence plate insurance is the minimum required across Canada. You may want to talk to an insurance professional to ensure you have enough protection in place. 10

15 Why does No Fault Coverage restrict my ability to sue for pain and suffering? When no fault insurance was introduced in Saskatchewan in 1995, the package of benefits was designed to meet virtually all of your needs if you re injured in an auto collision. It costs more to provide that package of benefits than the more basic package available through Tort Coverage. To keep insurance premiums affordable, the right to sue for pain and suffering was severely restricted and that money was put toward the No Fault package of benefits instead. Why is there no deductible on pain and suffering payments under No Fault Coverage? People with No Fault Coverage aren t able to sue for pain and suffering except in very limited circumstances. Therefore, a deductible wouldn t have much impact on the overall cost of No Fault claims and is unnecessary. I didn t know I could sue for expenses not covered under No Fault Coverage. Is this new? No. You can sue for expenses or other real loss in excess of the package of benefits. In most cases, your settlement will be negotiated between the responsible party s insurance company and you or your representative. Only when a negotiated settlement can t be reached is the matter referred to the courts. Am I more exposed to lawsuits since SGI introduced choice in auto injury insurance? Yes. Whether you have Tort or No Fault Coverage, the risk of being sued is greater. That s because someone with Tort Coverage injured in an auto collision can sue anyone responsible for expenses above their package of benefits. And the Tort Coverage package of benefits doesn t cover as many things as the No Fault Coverage package. So even if you have No Fault Coverage, if you cause a collision, your chances of being sued are greater. The $200,000 liability coverage provided under your licence plate insurance is the minimum required across Canada. You may want to talk to an insurance professional to ensure you have enough protection in place. 11

16 What happens when: A person with Tort Coverage causes a collision and injures a person with No Fault Coverage? The person with No Fault Coverage has immediate access to the package of benefits under No Fault Coverage and may also sue the Tort driver for any expenses above those benefits. They can t sue for pain and suffering, unless the Tort person has been convicted of impaired driving, of an offence for being criminally negligent, or of using a vehicle to intentionally harm the No Fault person. If the Tort person dies and was impaired, you have the right to sue the estate. A person with Tort Coverage causes a collision and injures another person with Tort Coverage? The injured person has immediate access to the package of benefits under Tort Coverage. The person may also sue the driver for any expenses above those benefits, and for pain and suffering. A person with No Fault Coverage causes a collision and injures a person with Tort Coverage? The person with Tort Coverage has immediate access to the package of benefits under Tort Coverage. The person may also sue the No Fault driver for any expenses above those benefits. They can sue for pain and suffering too, but the person won t sue the No Fault driver for it. The person will sue SGI. A person with No Fault Coverage causes a collision and injures another person with No Fault Coverage? The injured person has immediate access to the package of benefits under No Fault Coverage. They may also sue the at-fault driver for any expenses above those benefits. The person can t sue the driver for pain and suffering, unless the driver has been convicted of impaired driving, of an offence for being criminally negligent, or of using the vehicle to intentionally cause harm. If the at-fault driver dies and was impaired, you have the right to sue the estate. 12

17 Details of personal auto injury insurance No Fault Coverage No Fault Coverage offers a comprehensive package of benefits regardless of the circumstances of the collision. That means you have access to those benefits even if you were at fault for the collision or there s no one responsible to sue, such as if you re injured in a collision with a deer. The package of benefits available through No Fault Coverage is designed to meet most of the needs you d have if you were injured in an automobile collision. It includes income benefits, coverage for medical and rehabilitation expenses, a death benefit to your spouse and dependants in the event you re killed in an auto collision, as well as compensation for any permanent injuries as a result of the collision. You ll find more information on the package of benefits available under No Fault Coverage on page 15. There may be situations where the package of benefits doesn t cover all the expenses you have as a result of your injuries. For example, if you earn more than $96,034 per year, the income benefit available through No Fault Coverage won t cover your entire salary. In those cases, you can collect the difference from the people who caused the collision. With No Fault Coverage, in most cases you can t sue for pain and suffering. You also can t be sued for pain and suffering in most cases. If you re responsible for a collision, anyone you injure can sue you for expenses they have above their package of benefits. When you can sue under No Fault Coverage Your No Fault benefits are intended to cover most of your expenses. If you have expenses in excess of the package of benefits, you can sue the people who caused the collision for them. If you re going to sue, you must begin your legal action within two years of your collision. Those responsible may include: a driver or owner of another vehicle the driver or owner of the vehicle in which you were a passenger another party whose actions caused the collision, such as the manufacturer of a vehicle if a defect in the making of the vehicle caused the collision 13

18 In some situations you won t be able to sue for expenses above the package of benefits. These include when you re found to be responsible for the collision and situations where you re not responsible for the collision, but there s no one to sue, such as collisions with deer or other wildlife. In most cases, No Fault Coverage doesn t allow you or your family to sue for pain and suffering. However, there are a few situations where you or your family may be able to sue the responsible party for pain and suffering: The driver who caused the collision is convicted of impaired driving. The driver who caused the collision is convicted of an offence for being criminally negligent. If the responsible driver dies and was impaired. You were injured by someone who s convicted of using their vehicle to deliberately harm you. The negligence of a third party caused the collision in which you were injured. Third parties that can be held liable for your injuries include vehicle manufacturers, repairers and suppliers of parts, along with licensed drinking establishments. Pain and suffering settlements under No Fault Coverage aren t subject to a deductible. Collecting your losses Once those responsible are identified and you ve determined any expenses not covered by No Fault, you can take legal action against those who caused your collision. In virtually all cases it s the responsible party s insurance that will pay for your expenses. So you, or the representative you choose, will negotiate with the insurance company of those responsible. 14

19 When you can be sued under No Fault Coverage Those you injure can sue you for the difference between their package of auto injury insurance benefits and their actual expenses. A few examples of costs they may be able to collect include: If someone carrying Tort Coverage is totally disabled by injuries you ve caused in an auto collision, their package of benefits includes up to $438 per week to offset lost wages. If the injured person was earning $1,050 net per week, they can sue you for the difference ($612 per week). If the injured person with Tort Coverage is unable to care for their home because of their injuries and they must pay someone to do yard work and household chores, they may sue you for those costs. If the injured person with Tort Coverage has medical expenses in excess of the package of benefits, they may sue you for their extra costs. If you carry No Fault Coverage, in most cases those injured won t be able to sue you personally for pain and suffering. However, if you ve been convicted of impaired driving, of an offence for being criminally negligent, or deliberately harming someone with your vehicle, they ll be able to sue you for pain and suffering as well. If you die and were impaired and at fault for the collision your estate can be sued. In most cases, your insurance will pay for the losses you have caused to other people. But it s important to consider whether you have enough insurance coverage in place to protect yourself if you do cause a collision that results in losses to other people. Your independent insurance professional can help you decide what protection you need. Package of benefits under No Fault Coverage This section describes all the benefits No Fault Coverage provides, regardless of the circumstances of the collision. So if you caused the collision, or you don t have a responsible person to sue, you re still eligible for all the benefits described below. However, if you re driving while impaired, found criminally negligent, or use your vehicle to deliberately harm someone, your benefits may be reduced. The benefits described in this section are increased every year by a percentage equal to the Consumer Price Index, which means they are increased to match any increase in the cost of living. 15

20 Income benefit Income benefits are paid after the first seven calendar days following the collision in which you were injured. In all cases below, if the benefit doesn t cover your losses, you can sue those responsible for your collision for the difference. If you earn a salary Your income benefit will be calculated on the amount you were earning at the time of the collision. If you re unable to work because of your injuries, No Fault Coverage provides a benefit equal to 90% of your salary, less income tax, Canada Pension Plan and Employment Insurance deductions. The maximum income benefit you can receive is based on a gross salary of $96,034 per year. If you re self employed If you re a farmer, business owner or in any form of self-employment, you may choose any of the following calculations for your income benefit under No Fault Coverage: 90% of your average net income as reported on your income tax returns in the last three years, up to a gross salary of $96,034 per year a scheduled amount based on Saskatchewan income for your occupation and level of experience actual costs for a replacement worker, up to $45,136 per year If your business can t continue to run following your collision, your income benefit will be based on business income as well as certain fixed expenses, if the fixed expenses are unavoidable during the short term. Seasonal workers Your income benefit will be calculated on 90% of your salary at the time of your collision, less income tax, Canada Pension Plan and Employment Insurance deductions. If you re still unable to work 180 days after your collision, your benefit will be recalculated and based on the greater of your wages earned during the year before the collision, your average wage earned during the two years before the collision or minimum wage. If you did not work in your seasonal job before July 1st of the year prior to the year of the collision, your benefit will be recalculated based on your wage earned the year before the collision, your average wage earned during the two years before the collision, an average Saskatchewan income for your occupation and level of experience, or minimum wage whichever is greater. 16

21 Unemployed people If you were unemployed at the time of the collision, you won t receive an income benefit. If, after 180 days, you re still unable to work or perform the activities of daily living due to your injuries, you ll be paid an income benefit of no less than minimum wage. If you can prove you would have held a job within the 180 days after the collision if not for your injuries, you ll be paid an income benefit. You ll also be paid a benefit if your injuries cause you to lose Employment Insurance benefits. Caregivers If your main occupation at the time of the collision is taking care of your children younger than age 16, or of disabled adults and you re unable to provide care to those individuals because of your injuries, you ll be eligible for a caregiver benefit which will allow you to pay someone else to care for those people. The maximum caregiver benefit No Fault Coverage pays is $45,136 per year. If you remain unable to provide care after 180 days, you ll have a choice of being paid: actual and reasonable caregiving expenses subject to the maximum amount of $45,136 per year minimum wage if you can t perform your activities of daily living If you had intended to return to work, you may be entitled to an income benefit based on that employment. Students If you re unable to begin or continue your studies because of your injuries, No Fault Coverage will pay you a benefit until the time your studies were scheduled to be completed. Elementary school students can receive up to $5,525 per year. Secondary school students can receive up to $10,266 per year and students in post-secondary education can receive up to $20,531 per year. If your injuries prevent you from working after your studies were scheduled for completion, you ll begin to receive an income benefit. There s also a payment for any lost scholarship income and for any book or tuition expenses for which you re not able to get a refund. If you were working at the time of the collision as well as going to school, you ll be eligible for an income benefit in addition to your loss of studies benefit. 17

22 Seniors If you re older than age 65 at the time of the collision and you hold a job, you ll be paid an income benefit. The benefit will be gradually reduced over the next four years. If you re between 63 and 65 years old at the time of the collision and hold a job, and you are off work for at least 24 months because of your injuries, you ll receive a full income benefit for 24 months. At age 65 a lump-sum pension benefit will be paid. If you re more than 65 years old at the time of the collision and don t hold a job, you re not entitled to an income benefit. However, you still receive all other benefits to which you re entitled under your No Fault Coverage. Catastrophic injuries If you suffer a catastrophic injury, such as quadriplegia, paraplegia, a severe brain injury or total blindness, your income benefit will be based on your actual earnings. However, you re guaranteed a minimum annual benefit of $51,943 (the industrial average wage). The seven-day waiting period is waived in cases of catastrophic injury. Pension benefit If you re between the ages of 18 and 65 at the time of the collision and receive an income benefit for 24 consecu tive months or more because of your injuries, No Fault Coverage provides a pension benefit equal to 10% of the total income benefits you receive. You can choose to receive this benefit after your income benefit has concluded or at any time up to age 65. Medical and rehabilitation coverage If you re injured in an auto collision, No Fault Coverage will provide up to $6,888,630 for medical and rehabilitational expenses and will: give you access to comprehensive rehabilitation services cover the costs of medication compensate you for the time you re away from work to attend treatment cover your costs of travel, meals and related expenses while you attend treatment cover the costs of childcare if your main occupation is caring for your children and you are unable to care for them while you re at treatment 18

23 pay for living assistance if you need help with things like getting in and out of bed, getting dressed and undressed, bathing, preparing meals or doing household chores or yardwork pay for moving and labour costs for incomplete renovations if a person s injuries mean they must incur extra costs pay for costs of lost wages, meals, accommodations, transportation and other expenses for those attending to a seriously injured family member If the medical and rehabilitation benefits under No Fault Coverage don t cover all your medical and rehabilitation expenses, you can sue for costs above the benefits from those respon sible for your collision. Your rehabilitation plan will be developed by your doctor or practitioner in consultation with other medical professionals. It will be designed to meet your specific needs and flexible enough to take into account the unique circumstances of your situation. Your rehabilitation plan will continue for as long as is necessary to help you to recover from your injuries. Because your plan will be designed to help you recover from your injuries fully and quickly, if you don t participate in your rehabilitation plan you may hinder your recovery. SGI may not pay other benefits, such as lost wages. Why do I have to participate in rehab under No Fault? The goal of No Fault Coverage is to help you return to the way of life you had before your collision, as fully as possible. The package of benefits under No Fault is designed to cover virtually all of your expenses while you recover. It isn t meant to provide lifetime support unless you re catastrophically injured. There s an obligation on your part to participate in rehabilitation so that your injuries can heal to the greatest extent possible. Permanent impairment payment If you re permanently injured as a result of your collision, you may also receive a lump-sum payment above your other benefits. Each type of impairment is assigned a percentage value with the most serious receiving the highest percentage. The maximum benefit payment is $197,405 unless the injury is very serious, such as quadriplegia, paraplegia, a severe brain injury or blindness. In cases such as those, the benefit payment may be as high as $241,102. The payment will be provided at the one-year anniversary date of the collision together with interest from the date of the collision. If your injuries have not fully 19

24 healed at the one-year anniversary of the collision date it may be necessary for an additional payment once you have fully recovered, with interest payable from the date of the collision. Whiplash isn t considered a permanent impairment and isn t eligible for this benefit. Death benefit If you die as a result of a collision, your spouse and your dependants will receive death benefits. No Fault Coverage also provides $10,331 to cover the cost of your funeral. It also pays for grief counselling and may pay for financial counselling for your spouse and dependants. Your spouse will receive a benefit equal to 45% of your net income to a maximum gross salary of $96,034 per year. Your spouse will receive this benefit for their lifetime. Your dependent spouse may also qualify for an education benefit of up to $47,377 to assist them in preparing for the workplace. They may also be eligible for vocational counselling. Your spouse will also receive a benefit equal to 5% of the calculated death benefit for each dependant younger than age 21. This benefit will also be provided to disabled adults who are your dependants. If you are your dependant s only parent or if both parents are killed in an auto collision, the dependant will receive the spousal death benefit. They ll also receive 5% of the calculated death benefit for each dependant. These benefits will be shared among the dependants. Your surviving spouse and dependants may choose to receive their benefit every two weeks or they may choose to have the entire benefit paid out in a lump sum. If your spouse chooses to receive a lump-sum payment, No Fault Coverage guarantees a minimum lump-sum payment of $71,066. If you have no spouse or dependants, but you re survived by your parents or children older than age 21, each parent or child older than age 21 will be entitled to a $15,792 death benefit up to a maximum total payment of $71,066. If you have no spouse or dependants, your estate will receive a payment, in addition to the funeral benefit. If children younger than age 21, with no spouse or dependants, are killed in a collision, a lump sum of $31,584 will be paid to the estate. 20

25 If your spouse or dependants have a loss of the deceased s income contribution or funeral expenses in excess of the death benefits provided, they may sue those responsible for the collision for the difference. Appealing a decision made by SGI If you disagree with a decision SGI has made regarding your benefit payments, these are the steps you can take: You can take the matter to mediation. If you re still unsatisfied with the result, you can then go to either: the Automobile Injury Appeal Commission; or the Court of Queen s Bench. If you choose not to take the matter to mediation first, you can choose either: the Automobile Injury Appeal Commission; or the Court of Queen s Bench. 21

26 Details of personal auto injury insurance Tort Coverage Tort Coverage offers a basic package of benefits regardless of the circumstances of the collision. That means you have access to those benefits even if you were at fault for the collision or there s no responsible party to sue, such as if you re injured in a single-vehicle rollover. The package of benefits is designed to meet your basic needs if you re injured in a collision. It provides an income benefit to help offset any lost wages, some assistance with medical and rehabilitation expenses, a death benefit to your spouse and dependants in the event you re killed in a collision, as well as some compensation for any permanent injuries you have as a result of the collision. You ll find more information on the basic package of benefits available under Tort Coverage on page 25. There will be situations where the basic package of benefits doesn t cover all the losses you have as a result of your collision. In those cases, you can sue the people responsible for the collision for your losses, including for your actual expenses above the basic package of benefits and for pain and suffering. There are also circumstances in which Tort Coverage won t provide any benefits or compensa tion for your losses. Examples include if you were injured when driving while impaired by alcohol or drugs, if you ve used your vehicle to deliberately harm another person, if you were injured during a race or speed test, you were using your vehicle in an attempt to get away from a law enforcement officer while driving an unregistered vehicle or driving without a valid driver s licence. If you re at fault and convicted of criminal negligence you won t receive a permanent impairment benefit. If it is your second offence of criminal negligence in the last five years you ll also be denied an income benefit if you are at fault for the collision. Also, if you have Tort Coverage, you can be sued if you re responsible for a collision. Those you injure can sue you for any expenses they have above their package of benefits and they may be able to sue you for pain and suffering as well. When you can sue under Tort Coverage If you ve been injured in a collision and you have losses above those covered by the basic package of benefits under Tort Coverage, you can sue those responsible for the collision. If you re going to sue, you must begin your legal action within two years of your collision. 22

27 Those responsible may include: a driver or owner of another vehicle the driver or owner of the vehicle in which you were a passenger another party whose actions caused the collision, such as the manufacturer of a vehicle if a defect in the making of the vehicle caused the collision In some situations you ll receive only the basic package of benefits. These include if you re found to be responsible for the collision and situations where you re not responsible for the collision but there s no one from which to collect losses, such as collisions with deer or other wildlife. Types of losses for which you can sue In situations where you have someone to sue, there are several types of losses you may be able to collect. Here are some examples: If you re totally disabled by your injuries, the basic package of benefits includes up to $438 per week to offset lost wages. If your net earnings are actually $1,050 per week, you can sue those responsible for the difference ($612 per week). If you re unable to care for your home because of your injuries and you must pay someone to do your yard work and household chores, you may sue those responsible for these expenses. If you have medical expenses in excess of the package of benefits, you can sue for those expenses. If you expected to receive a promotion at work, but your injuries now prevent you from assuming those responsibilities, you can sue the people responsible for your collision for the wages you ve lost as a result. In addition to recovering expenses you ve had or may have, you may also sue for a pain and suffering payment under Tort Coverage. Pain and suffering payments aren t compensation for any out-of-pocket expenses you ve had. They re intended to compensate you for the difficulties or loss of enjoyment you ve had as a result of your injuries. The settlement you receive will be reduced by any costs covered by your package of benefits. Tort Coverage also applies a $5,000 deductible to any pain and suffering payment. That means if you receive a pain and suffering payment, the amount you receive will be reduced by $5,

28 So if it s determined you re entitled to a $20,000 pain and suffering payment and you ve received $3,000 in permanent impairment benefits, your pain and suffering payment will be reduced by the benefit payments and the $5,000 deductible. You ll actually receive $12,000 ($20,000 pain and suffering less $3,000 in benefits and $5,000 deductible = $12,000). Collecting your losses Once those responsible are identified and you ve determined the losses you ve had to date, and those you will have in the future as a result of the collision, you can take action against the people who caused your collision. In most cases it s the responsible party s insurance that will pay for the losses you ve had because of your injuries. So in most cases you, or the representative you choose, will negotiate with the insurance company of the responsible party. If you re unable to reach a settlement, you may choose to take your case to court. This process may take months or years. When you can be sued under Tort Coverage If you carry Tort Coverage and you re responsible for a collision, anyone injured can sue you. How much they can sue you for depends on how badly injured they are and which insurance coverage they ve chosen. Those you injure can sue for the difference between their package of auto injury insurance benefits and their actual expenses. A few examples of the kinds of losses they may be able to sue for include: If someone carrying Tort Coverage is totally disabled by injuries you ve caused in an auto collision and the injured person was earning $70,000 per year at the time of the collision, they can sue you for the difference between the income benefit to which they re entitled and their actual net salary. If the injured person is unable to care for their home because of their injuries and they must pay someone to do yard work and household chores, they may collect those costs from you. If the injured person was wearing a leather jacket at the time of the collision and it was damaged beyond repair as a result of the collision, they may collect the cost of replacing the jacket from you. 24

29 The people you injure may also be able to sue you for a pain and suffering payment. It s important to consider whether you have enough insurance coverage in place to protect yourself if you do cause a collision which results in losses to other people. Your insurance professional can help you decide what protection you need. Package of benefits under Tort Coverage This section describes all the benefits Tort Coverage provides, regardless of the circumstances of the collision. So if you caused the collision or you don t have someone to sue, you re still eligible for all the following benefits. You re not eligible for these benefits if you were impaired by alcohol or drugs at the time of the collision, were injured while using your vehicle to deliberately harm another person, were injured during a race or speed test, while trying to evade a law enforcement officer, while driving an unregistered vehicle or driving without a valid driver s licence. If you re at fault and convicted of criminal negligence you won t receive a permanent impairment benefit. If it is your second offence of criminal negligence in the last five years you ll also be denied an income benefit if you are at fault. The benefits described in this section are increased every year by a percentage equal to the Consumer Price Index, which means they are increased to match any increase in the cost of living. Income benefit Income benefits will be paid after the first seven calendar days following the collision in which you were injured. In all cases, if you have losses more than this benefit, you can sue those responsible for your collision for the difference. Employed people Tort Coverage provides an income benefit to people with a permanent, temporary, full-time or part-time job. If your injuries totally disable you so you re unable to do your job at all you ll receive up to $438 per week. This benefit will continue until you re able to return to work or for two years, whichever comes first. 25

30 If you remain totally disabled after two years to the extent you re unable to do any job you ll continue to receive an income benefit of up to $438 per week for life if required. If you have a job at the time of the collision and your injuries partially disable you so you re unable to do part of your job you ll receive up to $219 per week. Your benefit will continue until you re able to return to work or up to two years after the collision, whichever comes first. Unemployed people If you weren t working at the time of the collision, but you had held a job for six months or more in the year before the collision and your injuries totally disable you, you ll receive up to $438 per week. If your injuries partially disable you, you ll receive up to $219 per week. The benefit will continue until you re able to work again or up to two years, whichever comes first. If you remain totally disabled after two years to the extent you re unable to do any job you ll continue to receive an income benefit of up to $438 per week. If you didn t have a job at the time of the collision, but you had held a job for less than six months in the year before the collision, you re also eligible for an income benefit. If you re totally disabled, the benefit will equal the average wage you earned during the weeks you worked in the year before the collision or up to $219 per week, whichever is less. If you re partially disabled, the benefit will equal the average wage you earned during the weeks you worked in the year before the collision or up to $110 per week, whichever is less. The benefit will continue until you re able to work again or for two years, whichever comes first. Homemakers If you were a homemaker at the time of the collision and your injuries totally disable you so you re unable to perform all of your household duties you ll receive up to $438 per week. You ll receive this benefit until you re able to perform your household duties again or for two years after the collision, whichever comes first. If you were a homemaker at the time of the collision and your injuries partially disable you so you re unable to perform some of your regular household duties you ll receive up to $219 per week. This benefit will continue until you re able to perform all of your household duties again or for two years after the collision, whichever comes first. 26

31 Confinement benefit If you re not eligible for any of the income benefits described above, but you re hospitalized or your doctor has confined you to a bed or wheelchair, you re eligible for a benefit up to $219 per week. The benefit will continue until you re no longer confined or up to one year after the collision, whichever comes first. If you return to work or homemaking duties and require further medical treatment or suffer a relapse you will receive an income benefit for up to a maximum of 16 weeks within 104 weeks from the collision. Medical and rehabilitation coverage If you re injured in a collision, Tort Coverage will cover medical costs, costs of rehabilitation plans and some travel expenses for you to attend medical appointments or treatment centres. Tort Coverage will pay up to $26,960 in medical and rehabilitation expenses. If you suffer a catastrophic injury such as quadriplegia, paraplegia, a severe brain injury or blindness you re eligible for up to $202,200 in medical and rehabilitation costs. If your medical and rehabilitation expenses are more than these amounts, you can sue those responsible for your collision for the difference. With Tort Coverage, you have access to rehabilitation benefits. SGI s role in your rehabilitation is to pay for authorized medical treatments. However, SGI may not pay for all treatments you choose to take. Permanent impairment payment If you re permanently injured as a result of your collision, you may also receive a lump-sum payment above your other benefits. Each type of impairment is assigned a percentage value with the most serious receiving the highest percentage. The amount of the payment depends on how serious and disabling the injury. The maximum benefit payment is $13,480 unless the injury is very serious, such as quadriplegia, paraplegia, a severe brain injury or blindness. In cases such as those, the benefit payment may be as high as $175,240. The payment will be provided at the one-year anniversary date of the collision, together with interest from the date of the collision. If your injuries have not fully healed at the one-year anniversary, it may be necessary for an additional payment with interest payable from the date of the collision, once you have fully recovered. Whiplash isn t considered a permanent impairment and isn t eligible for this benefit. 27

32 Death benefit If you die as a result of a collision, your spouse and your dependants will receive death benefits. Tort Coverage also provides $6,740 to cover the cost of your funeral. Your spouse will receive a benefit based on your income at the time of your death. The payment will be equal to 45% of the deceased s net income to a maximum of $96,034. Your spouse will receive this benefit for their lifetime. Your spouse will also receive a benefit equal to 5% of the calculated death benefit for each dependant. If you are your dependant s only parent or if both parents are killed in the auto collision, the children will receive the spousal death benefit. They ll also receive 5% of the calculated death benefit for each dependant. These benefits will be shared among the dependants. Your spouse and dependants may choose to receive their benefit every two weeks, or they may choose to have the entire benefit paid out in a lump sum. If your spouse chooses to receive a lump-sum payment, Tort Coverage guarantees a minimum payment of $60,660. If you have no spouse or dependent children, your estate will receive a payment of $13,480 in addition to the funeral benefit. If your spouse or dependants have a loss in excess of the death benefits provided, they may sue those responsible for the collision for the difference. Appealing a decision made by SGI If you disagree with a decision SGI has made with respect to your responsibility for the collision or you disagree with a decision SGI has made regarding your benefit entitlement, you may take your dispute to court. 28