STATUTORY ACCIDENT BENEFITS SCHEDULE - EFFECTIVE SEPTEMBER 1, 2010, O. Reg. 34/10

• Jurisdiction: Ontario

Insurance Act

ONTARIO REGULATION 34/10

Statutory Accident bEnefits Schedule — Effective September 1, 2010

Consolidation Period: From April 11, 2022 to the e-Laws currency date.

Last amendment: 292/22.

This is the English version of a bilingual regulation.

Part I
General

Citation

1. This Regulation may be cited as the Statutory Accident Benefits Schedule — Effective September 1, 2010. O. Reg. 34/10, s. 1.

Application and transition rules

2. (1) Except as otherwise provided, the benefits set out in this Regulation shall be provided under every contract evidenced by a motor vehicle liability policy in respect of accidents occurring on or after September 1, 2010. O. Reg. 34/10, s. 2 (1); O. Reg. 251/15, s. 1 (1).

(1.1) The following provisions, as they read immediately before O. Reg. 251/15 came into force, apply in respect of accidents occurring on or after September 1, 2010 and before June 1, 2016:

1. The definition of “neuropsychologist” in subsection 3 (1).

2. Subsections 3 (2) to (6).

3. Subsection 15 (1).

4. Subsection 16 (3).

5. Section 38.

6. Subsection 39 (2).

7. Subsection 40 (8).

8. Subsections 42 (11) and (15).

9. Subsections 45 (2) and (4). O. Reg. 251/15, s. 1 (2).

(1.2) The following provisions, as they read immediately before O. Reg. 251/15 came into force, apply in respect of contracts entered into or renewed on or after September 1, 2010 and before June 1, 2016:

1. Section 12.

2. Subsection 17 (1).

3. Subsections 18 (3) to (5).

4. Subsection 19 (3).

5. Section 20.

6. Subsections 28 (1), (5) and (6).

7. Subsections 30 (1) and (4) to (8).

8. Subsections 42 (12) and (16).

9. Subsection 50 (3).

10. Subsection 57 (4). O. Reg. 251/15, s. 1 (2); O. Reg. 251/15, s. 1 (2).

(2) Subsections 25 (1), (3), (4) and (5), Parts VIII and IX, other than subsections 50 (2) to (5), and Parts X, XI and XII, as they read immediately before Ontario Regulation 251/15 came into force apply with such modifications as are necessary in respect of benefits provided under the Old Regulation with respect to accidents that occurred on or after November 1, 1996 and before September 1, 2010 and, for that purpose, the following rules apply:

1. References in paragraph 2 of subsection 25 (1), subsections 38 (1), (5), (7), (9), (10), (11), (12) and (14), sections 40 and 41 and subsection 44 (3) to the Minor Injury Guideline shall be read as references to the Pre-approved Framework Guideline referred to in the Old Regulation that would apply.

2. An amount that would, but for subsection 3 (1.3) of the Old Regulation, be paid under the Old Regulation after August 31, 2010 shall be paid under this Regulation in the amount determined,

i. under the Old Regulation, other than under section 24 of that Regulation, or

ii. under subsections 25 (1), (3), (4) and (5).

3. An amount described in paragraph 2 that is paid under this Regulation shall not include any amount previously paid under the Old Regulation. O. Reg. 34/10, s. 2 (2); O. Reg. 251/15, s. 1 (3).

(3) The benefits set out in this Regulation shall be provided in respect of accidents that occur in Canada or the United States of America, or on a vessel plying between ports of Canada or the United States of America. O. Reg. 34/10, s. 2 (3).

(4) Benefits payable under this Regulation in respect of an insured person shall be paid by the insurer that is liable to pay under subsection 268 (2) of the Act. O. Reg. 34/10, s. 2 (4).

(5) Subject to Part VII, the insurer shall pay the benefits under this Regulation despite section 225, subsection 233 (1), section 240 and subsection 265 (3) of the Act. O. Reg. 34/10, s. 2 (5).

Definitions and interpretation

3. (1) In this Regulation,

“accident” means an incident in which the use or operation of an automobile directly causes an impairment or directly causes damage to any prescription eyewear, denture, hearing aid, prosthesis or other medical or dental device; (“accident”)

“authorized transportation expense” means, in respect of an insured person, expenses related to transportation,

(a) that are authorized by, and calculated by applying the rates set out in, the most recent transportation expense guideline published by the Financial Services Regulatory Authority of Ontario, and

(b) that, unless the insured person sustained a catastrophic impairment as a result of the accident, relate to transportation expenses incurred only after the first 50 kilometres of a trip; (“frais de transport autorisés”)

“business day” means a day that is not,

(a) Saturday, or

(b) a holiday within the meaning of section 88 of the Legislation Act, 2006, other than Easter Monday and Remembrance Day; (“jour ouvrable”)

“chiropractor” means a person authorized by law to practise chiropractic; (“chiropraticien”)

“dentist” means a person authorized by law to practise dentistry; (“dentiste”)

“disability certificate” means, in respect of a person, a certificate from a health practitioner of the person’s choice that states the cause and nature of the person’s impairment and contains an estimate of the duration of the disability in respect of which the person is making or has made an application for a benefit described in this Regulation; (“certificat d’invalidité”)

“Guideline” means,

(a) a guideline, including the Minor Injury Guideline, issued by the Chief Executive Officer under subsection 268.3 (1) of the Act and published in The Ontario Gazette,

(b) a guideline that is included in the professional fee guidelines or the Optional Indexation Benefit Guidelines, as published in The Ontario Gazette by the Financial Services Regulatory Authority of Ontario, or

(c) a guideline published in The Ontario Gazette that is an amended version of a guideline referred to in clause (a) or (b); (“directive”)

“health practitioner” means, in respect of a particular impairment,

(a) a physician,

(b) a chiropractor, if the impairment is one that a chiropractor is authorized by law to treat,

(c) a dentist, if the impairment is one that a dentist is authorized by law to treat,

(d) an occupational therapist, if the impairment is one that an occupational therapist is authorized by law to treat,

(e) an optometrist, if the impairment is one that an optometrist is authorized by law to treat,

(f) a psychologist, if the impairment is one that a psychologist is authorized by law to treat,

(g) a physiotherapist, if the impairment is one that a physiotherapist is authorized by law to treat,

(h) a registered nurse with an extended certificate of registration, if the impairment is one that the nurse is authorized by law to treat, or

(i) a speech-language pathologist, if the impairment is one that a speech-language pathologist is authorized by law to treat; (“praticien de la santé”)

“impairment” means a loss or abnormality of a psychological, physiological or anatomical structure or function; (“déficience”)

“insured automobile” means, in respect of a particular motor vehicle liability policy, an automobile covered by the policy; (“automobile assurée”)

“insured person” means, in respect of a particular motor vehicle liability policy,

(a) the named insured, any person specified in the policy as a driver of the insured automobile and, if the named insured is an individual, the spouse of the named insured and a dependant of the named insured or of his or her spouse,

(i) if the named insured, specified driver, spouse or dependant is involved in an accident in or outside Ontario that involves the insured automobile or another automobile, or

(ii) if the named insured, specified driver, spouse or dependant is not involved in an accident but suffers psychological or mental injury as a result of an accident in or outside Ontario that results in a physical injury to his or her spouse, child, grandchild, parent, grandparent, brother, sister, dependant or spouse’s dependant,

(b) a person who is involved in an accident involving the insured automobile, if the accident occurs in Ontario, or

(c) a person who is an occupant of the insured automobile and who is a resident of Ontario or was a resident of Ontario at any time during the 60 days before the accident, if the accident occurs outside Ontario; (“personne assurée”)

“minor injury” means one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury; (“blessure légère”)

“Minor Injury Guideline” means a guideline,

(a) that is issued by the Chief Executive Officer under subsection 268.3 (1.1) of the Act and published in The Ontario Gazette, and

(b) that establishes a treatment framework in respect of one or more minor injuries; (“Directive sur les blessures légères”)

“neuropsychologist” means a psychologist authorized by law to practise neuropsychology who has been registered to practice as a neuropsychologist in Canada for a minimum of five years; (“neuropsychologue”)

“occupational therapist” means a person authorized by law to practise occupational therapy; (“ergothérapeute”)

“Old Regulation” means Ontario Regulation 403/96 (Statutory Accident Benefits Schedule — Accidents on or After November 1, 1996), made under the Act; (“ancien règlement”)

“person in need of care” means, in respect of an insured person, another person who is under 16 years of age or who requires care because of physical or mental incapacity; (“personne ayant besoin de soins”)

“personal and vocational characteristics” include,

(a) employment history,

(b) education and training,

(c) vocational aptitudes,

(d) vocational skills,

(e) physical abilities,

(f) cognitive abilities, and

(g) language abilities; (“caractéristiques personnelles et professionnelles”)

“physician” means a person authorized by law to practise medicine; (“médecin”)

“physiotherapist” means a person authorized by law to practice physiotherapy; (“physiothérapeute”)

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