Out- of- Pocket Damages /  Economic Loss

The expenses you incur and the income you lose are often very significant components of your claim for compensation.  Generally, these are objective costs to you which can be calculated with relative ease as long as someone is keeping track.

Medical and Rehabilitation Expenses

As an injured person, you will likely require health care services that are not covered by OHIP, such as physiotherapy, occupational therapy, chiropractic, massage, prescriptions, prolotherapy, psychology, vocational rehabilitation, dentistry and in catastrophic cases, additional services such as case management.  If you have extended health care benefits that cover all or some of these services, you will have to submit your expenses to that insurer first.

If you do not have extended health care or if there is a deductible (for example if they only pay 80%) or an annual limit for expenses that you exceed,  or a particular service is not covered, you will have access to the medical and rehabilitation policy of the Accident Benefit insurer.  You and your treatment providers will make arrangements to have your services paid directly by the Accident Benefit insurer, in most situations. 

However, if there are accident-related services that are not covered, you or your lawyer will need to track those expenses to claim them from the at-fault driver.  In addition, there is a policy limit for Accident Benefits depending on the severity of the accident (either $100,000 or $1,000,000).  Anything over and above the Accident Benefits’ limits would also be claimed from the at- fault driver.

Loss of Income

Ontario accident victims are only entitled to 80% of their pre-trial loss of income.   They are entitled to 100% of post-trial losses.

If you had a straight salaried position that you can no longer do, it will be relatively easy to calculate your past loss of income.  However, you will want to be aware of any raises or bonuses your co-workers received if you would have received the same. 

Calculating your loss of income is trickier when your pre-accident work was irregular, your career was on an upward trajectory or market conditions in your position were changing, for better or for worse.  It is also more challenging to calculate income loss for people who are self-employed.

If you are retrained to work at another position, the income from your new position will have to be factored into your claim for losses.

It is vitally important to track, calculate, document, and fairly project your loss of income claim and any related loss of a future pension.  We commonly use an economist, forensic accountant and / or an actuary to perform these types of calculations.

Other Types of Expenses

Out of pocket expenses for other services you are required to purchase because of your accident should also be tracked.  For example, if you are unable to drive for four months because of a leg cast, you will have had transportation expenses.  You will need receipts and records to prove those losses.  If you were driven by a loved one, a record of that person’s time will be important.

If you have to hire a babysitter to look after kids because you cannot take care of them  due to your injuries or to get to medical appointments, and you did not qualify for the caregiver benefit under the Accident Benefits, you can claim these expenses from the at-fault driver if you have accurate records and can prove your losses.