North City General Insurance Brokers

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Optional Accident Benefits Confirmation Form

* Please choose an option for each of the 7 coverages below. If you wish to choose additional coverage please contact our office immediately for correct pricing.
  • The standard benefit pays up to $65,000 for medical, rehabilitation and attendant care expenses for non-catastrophic injuries. If catastrophically impaired, the standard benefit pays up to $1,000,000 for medical, rehabilitation and attendant care expenses. You can purchase optional medical, rehabilitation and attendant care benefits for non-catastrophic injuries of $130,000. You can purchase optional benefits for catastrophic injuries to $2,000,000 or increase medical, rehabilitation and attendant care benefits to $1,000,000 for non-catastrophic injuries and $2,000,000 for catastrophic injuries.
  • The standard caregiver, housekeeping and home maintenance expenses benefit is available only for a person who is catastrophically impaired. You can purchase an optional benefit to provide this coverage for all impairments.
  • The standard level of income replacement provided in the policy, $400/wk maximum, can be increased to $600/wk, $800/wk or $1,000/wk. Requested Income Replacement Option
  • What Income Replacement Benefit (IRB) is best for your customer?

    Is your income close to or greater than Consider an IRB at this level
    $30,000/year?$600/week
    $45,000/year?$800/week
    $60,000/year?$1,000/week
  • There is no standard dependant care benefit for persons who are employed and care for dependants. You can purchase an optional benefit to receive additional weekly dependant care expenses of $75/wk for the first dependant and $25/wk for each additional dependant, up to $150/wk.
  • The standard level of death benefits paid to the surviving spouse and dependant of a person who is killed - $25,000 to surviving spouse, $10,000 to surviving dependant can be doubled by purchasing this optional coverage. This coverage also increases the standard funeral expense benefit from $6,000 to $8,000.
  • This optional coverage will ensure that certain weekly benefit payments and monetary limits will increase on an annual basis to reflect changes in the cost of living.
  • This endorsement will provide a buy down on the deductible currently imposed by the Insurance Act on any settlement you may be awarded for pain and suffering following an automobile accident.
  • Please provide your contact information. Our team will be in touch with you shortly.

The North City Advantage

  • Three decades of experience
  • Tailored and competitive programs
  • Exceptional savings
  • We’re here to serve you
  • Personalized broker service
  • Group membership offers benefits

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North City Stories

I want to compliment North City and Aviva for their response to our recent claim.  While the flood we sustained was minor in nature is was severe enough to upset our household and lifestyle for a considerable time frame.  Through the efforts of the adjuster and all involved, our home is now back to normal.  From your office staff to the people on site doing the work, everyone was diligent and professional in their approach to our claim.

J.W.(Jim) Douglas – Fire Chief Retired, Fort Erie, Ontario