Modifications To Your Home After An Accident

People who sustain injuries in a car accident or other motor vehicle accidents are entitled to certain insurance coverage from the Ontario Accident Benefit scheme. This is sometimes referred to as no-fault insurance.

Injured people, especially those who suffer mobility impairments, often face the challenge of being discharged from a rehabilitation centre, (The Ottawa Rehabilitation Centre, The Ottawa Hospital-Civic Campus or Elizabeth Bruyere, in Eastern Ontario) only to return to their house that cannot accommodate them.

This problem is addressed, in part, by the Accident Benefits which include home modifications / renovations as some of the benefits available to injured people in Ontario.

THE STATUTORY ACCIDENT BENEFIT SCHEME

Generally, people injured in Ontario car accidents can receive accident benefits. The benefits are usually paid by their own car insurance company. However, the scheme also provides coverage for people who do not have their own insurance.

Usually, statutory accident benefits are there to replace missed salary, attendant care, rehabilitation and medical needs as well as death benefits.

There is a section in the Accident Benefits regime (section 15) that says that "all reasonable and necessary" rehabilitation expenses are to be paid. The purpose of the rehabilitation expenses are to reduce or eliminate the impact of a disability caused by the accident. Home renovations, assistive devices, workplace adaptations and vehicle modifications are all items which may be covered under section 15 of the Accident Benefit regime for "rehabilitation" benefits.

Housing

The insurance company also states that an insurance company must pay the injured person for all reasonable and necessary home modifications and home devices, including communication aids.

The Accident Benefits regime specifically allows for the purchase of a new home for the injured person where purchasing a new home to accommodate the injured person's needs makes more sense than to renovate his or her existing home. However, the amount allocated for the purchase of a new home must not exceed the value of the renovations to the injured person's existing home that would be required to accommodate the injured person's needs.

If the existing home is incapable of being modified to accommodate the injured person, the only limit on the amount available to purchase a new home is the policy limits for this category of benefits.

WHAT ARE THE POLICY LIMITS? HOW MUCH DO YOU HAVE TO SPEND?

The medical and rehabilitation benefits are supposed to pay for all reasonable and necessary expenses that arise because of the accident.

Home modification comes under the medical / rehabilitation category.

For the purpose of calculating how much money is available, the medical benefits and the rehabilitation benefits are combined.

If the injured person did not suffer a "catastrophic impairment" as that is described in the Accident Benefit regime, the total amount of the medical / rehabilitation benefit is $100,000 and the benefits expire after 10 years from the date of the accident

If the injured person did suffer a "catastrophic impairment" the medical / rehabilitation benefit increases to $1 Million and last for the person's entire life.

HOW DO YOU GET THE BENEFITS?

You must notify your insurance company that you have had a car accident within 7 days of the accident, or as soon as possible, and you must complete your application for Accident Benefits within 30 days. While it is not fatal to your application if you miss these deadlines by a small margin, you should submit your applications as soon as possible.

Once you have successfully applied to the insurance company for Accident Benefits, the first step to get modifications is to obtain a home-site assessment.

These assessments provide realistic, practical suggestions to help the injured person to live safely and reasonably in his or her house. The assessment focuses on returning the person who is injured to a level of function that approaches his or her pre-accident state to the extent that that can be done safely.

Injured people with catastrophic or near catastrophic injuries may require other assessments as well, including a housing accessibility report, an alternative housing report.

The insurance company normally pays for the home-site and work-site assessments if they approve the assessment in advance. To get approval of this type of assessment, the injured party or his or her lawyer has to arrange for the completion of a form called an "OCF-22: Application for Approval of an Assessment or Examination".

Keep in mind that the person conducting the assessment is often not a regulated health professional and therefore will not be permitted to complete the OCF 22. An occupational therapist, a case manager or even a family doctor or physiotherapist can complete the form.

The OCF 22 will be reviewed by the insurer. If it is approved, the assessment can take place. The assessment will result in a report. Once the report is generated, and if the insurance adjuster requires it, another form called a "OCF 18: Treatment Plan" is filed with the insurer, detailing the estimated expense of the suggestions in the report. The renos can start once the OCF 18 (treatment plan) is approved.

ARE HOME MODIFICATIONS PERMITTED FOR NON-CATASTROPHIC INJURIES?

In some situations, the answer is yes. Where the injured person has suffered injuries that cause impairment but are on the less serious end of the spectrum, and if the renovations are not going to be extensive, an occupational therapist will perform a home assessment.

A home assessment is an assessment of the injured person's activities of daily living including from before the accident. This assessment looks at personal care, housekeeping, home maintenance and care giving tasks. The Occupational Therapist also provides a breakdown of any recommended assistive devices, home modifications and simple home renovations in the report. Examples of recommendations in this type of assessment include adding a stair railing, raising or lowering a bed or counter or adding hip-level storage in a kitchen.

If the renos suggested by the therapist are final, they can be filed with the insurer, together with an OCF 18 (Treatment Plan) that expenses the recommendations to get the insurer's approval to proceed.

HOW TO ACCESS THESE BENEFITS FOR CATASTROPHICALLY INJURED PEOPLE

If a person is seriously injured and needs significant home modifications like ramps, additions, elevators, walls moved, a home accessibility report is required.

A home accessibility report is centered around the injured person's housing requirements. The report identifies the client's housing requirements, a description and pictures or drawings of the current home. It also outlines the home modifications and renovations that would be needed to meet the client's housing needs at the current house.

The report on house accessibility will itemize the cost and will outline the plan for any contemplated renos. The report addresses municipal by-laws and construction issues that are generally outside the scope of practice of an occupational therapist.

After the report is ready, and the person who is injured decides to go ahead with a proposed reno, a treament plan (OCF 18) is filed with the insurer to be approved.

There are situations where the renovations to an existing home simply to not make sense. In that circumstance, it can be better to simply purchase a new home for rather than try to renovate the current one.

The choice to purchase a new home versus renovating the current home can be based on some of the following considerations:

*Is the current home a rental or social housing?

* Are the renovations required so extensive that they will exhaust or exceed the policy limits or just not make financial sense?

* Are the renovation not allowed due to municipal restrictions?

* Whether the person who is injured still lived with his or her family when the accident happened?

* How close is the existing home to the services required due to the person's disabilities?

The housing benefit under s. 15 of the Accident Benefits is among the most significant aspects of most claimants' no fault claim.