Section 12(1) of the Statutory Accident Benefits Schedule (SABS) grants children entitlement to Non-Earner Benefits (NEB). Nevertheless, insurance companies frequently contend that section 12(3) precludes children from receiving NEB. In a groundbreaking decision in the recent case of DC v TD Insurance Meloche Monnex (2023, ONLAT 21-015015/AABS) (“DC v TD”), children can now claim $18,500 in non-earner benefits if they meet specific criteria within two years following a motor vehicle accident.
In DC v TD, a seriously injured 12-year-old was found eligible for the full $18,500 in non-earner benefits, to be paid when they turn 18. The Arbitrator interpreted the legislation’s reference to ‘elementary’ students as including children, thus making these benefits available to them.
To be eligible for non-earner benefits, the Disability Certificate (OCF-3) must confirm a ‘complete inability to lead a normal life’ as a result of the accident. This condition is frequently met by individuals who have had prolonged hospital stays shortly after the incident. It’s crucial to emphasize that the assessment is based on the individual’s condition at the time of certificate completion and does not take into account future potential improvements.
The arbitrator’s decision clarifies that the $18,500 is payable without interest once the minor turns 18. To remain eligible, the injured child must continue to meet the test for entitlement in the two years following the accident, not after turning 18.
