Canadian Underwriter

Ontario updates attendant care rates payable under auto insurance policies

May 23, 2014   by Canadian Underwriter

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The Financial Services Commission of Ontario is revising the hourly rate guideline for attendant care benefits in the province’s standard auto insurance policy, raising the amount payable for “basic supervisory functions” to $11 an hour, for accidents that occur on or after June 1 of this year.

The rates “applicable to accidents occurring on or after September 1, 2010 and before June 1, 2014” are governed by a guideline published in 2010, which had set the rate for unskilled attendants at $10.25 per hour. 

As of June 1, Ontario’s minimum wage will rise from $10.25 to $11 per hour. FSCO’s Attendant Care Hourly Rate Guideline “establishes the maximum expense that automobile insurers are liable to pay” for attendant care services under the Statutory Accident Benefits Schedule (SABS), also known as Ontario Regulation 34/10.

The rate for “routine personal care” and for “complex health/care and hygiene functions” are unchanged from 2010, at $13.19 and $19.35 per hour respectively.

Ontario auto insurers “are not liable for any administration or any other charges or surcharges that have the result of increasing the effective hourly rate beyond what is payable” under the guidelines, FSCO notes. This essentially means they are not required to pay surcharges to cover administration costs or overhead.

Under Ontario’s standard auto policy, the maximum attendant care benefit that can be paid is $3,000 per month if the victim did not sustain a catastrophic impairment. The maximum is $6,000 per month if the insured person did sustain a catastrophic impairment. Policyholders have the option to purchase additional coverage.

Attendant care benefits are for “services provided by an aide or attendant or by a long-term care facility, including a long-term care home under the Long-Term Care Homes Act, 2007 or a chronic care hospital.”

For policyholders who did not purchase optional additional coverage, the maximum coverage available is $1 million for a catastrophic impairment and $36,000 for other cases. Attendant care benefits are not payable more than 104 weeks after an accident, unless optional additional coverage is purchased.

When attendant care is provided by a family member or someone who is not providing the care in the course of employment, the amount is limited to the economic loss sustained by the caregiver.

In a change that took effect Feb. 1, 2014, the province clarified the amount that could be claimed by someone caring for a vehicle accident victim who is not acting “in the course of the employment, occupation or profession in which the attendant care provider would ordinarily have been engaged for remuneration, but for the accident.”