Income Replacement Benefits in Ontario

By Matt Lalande in Accident Benefits (SABS) on January 19, 2019

Income Replacement Benefits in Ontario


For an accident victim, nothing is more Stressful than the Lack of Cash Flow

Accident can send people into brutal crushing debt. When the cashflow stops all facets of a family’s financial life can be negatively affected, from paying the mortgage or car payments to paying for your kids’ hockey and dancing. Nothing is more stressful on an individual or family than the loss of income.

If you or a loved one has suffered a serious injury of impairment because of a car accident, motorcycle accident, trucking accident, truck accident or any other type of accident involving a motor vehicle, you may be entitled to what is called an income replacement benefit to help supplement your finances.

Income Replacement Benefits (otherwise called IRBs for short) play a essential role in the management of an your accident benefits claim under what is called the Statutory Accident Benefits Scheduleotherwise called SABS for short.  The SABS are the law which governs which benefits YOUR OWN insurance company you be be eligible for if you are hurt in a motor vehicle accident.

Income Replacement Benefits are designed to help accident victims that are struggling to support themselves or their families following a motor vehicle accident in Ontario. The IRB is intended to compensate accident victims for their loss of income from employment or self-employment, so long as the accident victim meets the necessary requirements.

How do I qualify for an Income Replacement Benefit?

Entitlement to IRB’s depends on whether you were working on not at the time of the accident.

Were working at the time of your accident?

If you were working at the time of your accident, the benefit rules state that you must have been employed or self-employed at the time of the accident and you developed an impairment within 104 weeks of the accident. As a result of that accident related impairment, you are unable to perform the substantial duties of your job.

What if you were not working at the time of the accident?

In some cases, victims who were not working at the time of the accident may still qualify for income replacement benefits. If you were not working at the time of the accident, you must have been employed in the 26 of the 52 weeks prior to the accident, or you were receiving benefits under the Employment Insurance Act, S.C. 1996, c. 23 (Canada) at the time of the accident.

How much Income Replacement Benefit can I receive from my insurance company if I am hurt?

You are entitled to receive up to 70% of your gross pre-injury income, up to a maximum of $400.00 per week.

How long can I get Income Replacement Benefits for in Ontario?

You can receive income replacement benefits up to the age 65. At that point, the benefits are ramped down but payable to your estimated life expectancy. If your entitlement to receive income replacement benefits begins on or after your 65th birthday, the amount of the IRB payable is for steadily decreases over the 208 weeks that it is payable.

What if I have have been receiving under-the-table or undeclared income?

This can be a problem. This type of income will not be included in any calculations of pre-accident income. There is a general requirement that all income must be declared on your tax returns in order to be included in your income replacement benefit calculation.

Is there anything that can be deducted from my income replacement benefits?

There can be. The base weekly income replacement benefit calculation incorporates a deduction for what you call “collateral benefits.” A simpler way to think about this is that you can’t get paid twice.  Your insurance company is also allowed to deduct from your benefit certain collateral benefits that your may be receiving due to present or previous injuries.  It is very important to tell us about any collateral benefits you are receiving before you apply for income replacement benefits. If you don’t, and the insurance company finds out, you may be asked to repay the insurance company for any excess amount. 

Examples of certain deductions can be a CPP Disability, Short Term Disability and Long-Term Disability.  An insurer can also deduct temporary benefits such as EI or the Employment Insurance Act and certain benefits payable under WSIB (paid under s. 43.3).

How  do I apply for an income replacement benefit?

You must submit an application for accident benefits. You must elect between a non-earner benefit or an income replacement benefit and you must submit a disability certificate (OCF-3). Your insurance company will provide you with an application with accident benefits (which we can of course help you fill out).

Youc an also find a copy of the Disability Certificate on the FSCO website.  Your Disability Certificate is divided into 10 parts. Parts 1-4 are to be completed and signed by the claimant before giving the form to a health practitioner. The health practitioner then completes the rest and submits it to the insurance company. You may want our help with this to ensure consistency and accuracy.

Parts 5-10 are to be completed and signed by one of the following health practitioners:

  • Chiropractor.
  • Dentist.
  • Nurse Practitioner.
  • Occupational Therapist.
  • Optometrist.
  • Physician.
  • Physiotherapist.
  • Psychologist.
  • Speech Language Pathologist.

The list is broad, and the Disability Certificate will carry more weight if it is completed by a health practitioner:

  • Whose area of practice is related to the primary diagnosis.
  • Who treated the claimant prior to the accident.
  • Who is funded by OHIP.

Your family doctor is often a good choice.

What’s the next step after applying for my income replacement benefit?

Within 10 days of receiving your submitted Disability Certificate, section 36(4) of the SABS requires the your insurance company insurer to either pay your income replacement benefit or give you notice explaining the medical or non-medical reason for the denial. Your insurance company can also have you attend at an examination under section 44 related to the income replacement benefit.

What happens after my insurance company receives my S.44 Independent Medical Assessment Report?

If your insurance company  required you to attend an examination under section 44 of the SABS, within 10 days your insurance company must (section 36(7), SABS) give a copy of the report, give a copy of the report to the health practitioner who completed the Disability Certificate. Your insurance company must also give you notice setting out the amount your insurance company agrees to pay for income replacement benefits, if any. You insurance company must also advise of any amount that it refuses to pay for income replacement benefits, if any; and the medical and non-medical reasons for your insurance company ’s decision.

If your insurance company agreed to pay an amount, it must start payments within 10 business days after delivering the notice (section 36(8), SABS).

Do you have questions concerning an Income Replacement Benefit?

If you have suffered life changing injuries and you have any questions relating to your income replacement benefits please call our Hamilton Personal Injury Lawyers at 905-333-8888 or chat with our live website operator 24/7 to help book an appointment. We never ask for fees upfront and our consultations are always free.  Let our family help yours.




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