What Rights Do MVA Patients Have in Ontario?

As an MVA patient in Ontario, you have extensive rights under the Statutory Accident Benefits Schedule (SABS), regardless of who was at fault for the accident. Ontario operates under a no-fault insurance system, which means your injuries are eligible for insurance coverage under the SABS regardless of who was responsible for the accident. Your fundamental rights include:

• Immediate Access to Treatment: You have the right to seek emergency medical care and treatment within the first five days after your accident without requiring pre-approval from your insurance company. This ensures you can receive critical care when you need it most.
• Comprehensive Rehabilitation Services: You're entitled to medical and rehabilitation benefits that cover the cost of health care and rehabilitation, including physiotherapy, chiropractic care, massage therapy, counselling, and other services not covered by OHIP or through your group plan.
• Right to Choose Your Healthcare Provider: You can select IMPACT Chiropractic to provide your rehabilitation services. You're not restricted to specific clinics unless your insurance policy has particular network requirements.
• Privacy Protection: Your personal health information is protected under privacy legislation, and you have the right to control who accesses your medical records and treatment information.
• Appeals Process: If your insurance company denies benefits or treatment, you have the right to appeal these decisions through the Automobile Accident Benefits Service (AABS) or the License Appeal Tribunal (LAT).
• Documentation Rights: You're entitled to receive copies of all forms, reports, and correspondence related to your claim. Your healthcare providers must provide you with documentation to support your insurance claims.

Understanding how MVA insurance coverage works in Ontario is essential for accessing your rehabilitation benefits effectively. The amount you receive in compensation will depend on the extent to which the insurance company found you to be at fault and the type of insurance coverage you purchased.

Basic Coverage Levels

• Minor Injury Guideline (MIG): If your injuries are classified as minor (sprains, strains, whiplash-associated disorders, contusions, abrasions, lacerations, or subluxations), you may be eligible for up to $3,500 in medical and rehabilitation benefits. Treatment under the MIG can begin immediately, provided an OCF-23 Treatment Confirmation Form is completed.
• Non-Catastrophic Injuries: For injuries that fall outside the MIG classification, coverage is capped at $65,000 for attendant care and medical and rehabilitation expenses unless you have purchased optional benefits. This level provides significantly more comprehensive rehabilitation support.
• Catastrophic Injuries: If a patient has a catastrophic impairment, they are eligible for a combined total of $1,000,000 for medical catastrophic injury coverage. Catastrophic benefits are available for life to cover medical, rehabilitation and attendant care.

Priority of Payment

Recent changes require auto insurers to pay for medical and rehabilitation expenses for injuries sustained as a result of an auto accident before these expenses are paid under a supplementary health insurance plan. This means your auto insurance becomes the primary payer for MVA-related treatments.

Coverage Regardless of Fault

If someone does not have an auto insurance policy but was involved in a motor vehicle accident as a passenger, cyclist, or pedestrian, they are still eligible to claim the insurance of the vehicle's driver.

MVA rehabilitation coverage in Ontario is comprehensive and designed to support your complete recovery. The specific treatments covered depend on your injury classification and the medical necessity, as determined by our healthcare professionals.

Covered Rehabilitation Services

• Physiotherapy: Comprehensive physiotherapy services including manual therapy, therapeutic exercises, modalities, and functional rehabilitation to restore mobility, strength, and function.
• Chiropractic Care: Spinal adjustments, soft tissue therapy, and other chiropractic interventions to address musculoskeletal injuries commonly resulting from motor vehicle accidents.
• Massage Therapy: Registered massage therapy to address soft tissue injuries, reduce pain, improve circulation, and support overall recovery.
• Acupuncture: Traditional and contemporary acupuncture treatments for pain management and healing support.
• Specialized Therapies: Advanced treatments such as shockwave therapy, cold laser therapy, ultrasound, and electrotherapy when medically indicated.
• Custom Orthotics and Bracing: Custom-fitted orthotic devices and bracing solutions support injured joints and improve biomechanical function during recovery.
• Psychological Support: Counselling and psychological services to address emotional trauma and mental health impacts following an accident.
• Attendant Care: Professional care services if you require assistance with daily activities due to your injuries.
• Medical Equipment and Devices: Necessary medical equipment, assistive devices, and therapeutic aids are required for your recovery.
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Treatment Planning Requirements

Unless your insurance company waives the requirement of an OCF-18, a Treatment Plan must be completed before the reimbursement of medical and rehabilitation benefits. For minor injuries, an OCF-23 Treatment Confirmation Form allows treatment to begin without pre-approval.