At Fault Accidents: Available Benefits and Fault Determination

The Statutory Accident Benefits Schedule (SABS) is Ontario’s no-fault insurance system. Fault does not matter when claiming these benefits through an insurer.

Regardless of the existence of no-fault insurance coverage, insurance companies conduct an investigation to determine who was at fault as soon as an accident is reported. This is because fault is important for allocating liability for damages. This information may be used by insurers, parties to litigation, and the courts.

This article discusses the available benefits for any accident, which benefits require determination of fault, and how fault is determined based on the benefit being sought.

Available Benefits for All Accidents

Statutory Accident Benefits are part of every Ontario auto insurance policy and are available to every insured Ontario driver. If, after an accident, an individual needs to recover health care costs or financial replacement benefits, they can apply for SABS through their insurer.

The insurer pays these benefits regardless of who caused the accident. They may include medical and rehabilitation benefits, income replacement benefits, and attendant care benefits. For damages and/or compensation beyond these benefits, a claimant will have to make other types of claims, and these are based on fault.

Benefits That Require Determination of Fault

The availability of no-fault insurance in Ontario does not negate the need to determine who is at fault. For one, the insurance company needs to know who is at fault because this information goes on the driver’s driving record. The at-fault driver is required to pay a penalty, which can include higher premiums on their insurance for a period of time.

But determining fault is also important in regard to two other components of Ontario insurance policies. That is, who was at fault will affect how much each driver involved in the auto accident can recover for property damage and personal injury.

In terms of property damage, an individual may pursue a Direct Compensation-Property Damage (DC-PD) Coverage claim. This type of coverage provides compensation for damage to an individual’s vehicle and is based on the extent to which another driver is found at fault.

In terms of personal injury, an individual’s Third-Party Liability Coverage covers the damages in a tort claim. This covers the costs that an insured driver must pay to another driver when they cause an accident. In other words, if you’re at fault in an accident and an injured party pursues a tort claim, this is the part of your insurance policy that covers the cost of those damages.

It is possible for more than one driver to be found partially at fault for an accident. An investigation will determine the degree of responsibility of each driver. For example, if an injured person is found partially at fault, then the amount they can recover under each policy is reduced according to that degree of fault.

How to Determine Fault for Property Damage Claims

Determining fault for property damage claims requires the Fault Determination Rules under Ontario’s Insurance Act. These rules and charts describe more than 40 common accident scenarios.

The circumstances of an accident are compared to these scenarios to find a match. If no match exists, or if there isn’t enough information to determine the particular circumstances of an accident, fault is assigned “in accordance with the ordinary rules of law.”

The Fault Determination Rules are only used to determine fault for the purpose of Direct Compensation-Property Damage claims and they do not take into consideration things like weather, visibility, or point of impact. These issues are only important in a tort claim.

How to Determine Fault for Personal Injury

Determining fault for personal injury claims is based on negligence. That is, evidence must be presented that demonstrates that one or more people were negligent or acted carelessly and that this negligent or careless behaviour caused the accident.

Example of negligent or careless behaviour includes speeding, running a stop light, driving under the influence, or driving distractedly. A person who is found negligent and whose negligence causes an accident is at fault for the accident.

If both the plaintiff and the defendant are found to have acted negligently, then the plaintiff’s compensation is reduced according to the degree to which he or she was at fault.

Helping You Determine Fault

The existence of no-fault insurance won’t stop insurers from investigating who caused an accident.  Knowing who was at fault is important for property damage and personal injury claims, as well as an individual’s driving record and insurance premiums.

But the ways in which fault is determined are complicated and vary depending on the claim being made. For that reason, it’s important to seek legal help whenever you’re involved in an automobile accident in Ontario, either as a driver, cyclist, or pedestrian. Sharma Law can help you navigate your eligibility for compensation in all situations.

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