What Is It?
Ontario’s Statutory Accident Benefits Schedule (SABS) requires all Ontario auto insurance policies to include accident benefits coverage — also called no-fault benefits. These benefits are available to anyone injured in a car accident in Ontario, regardless of fault:
- Drivers
- Passengers
- Pedestrians and cyclists hit by a vehicle
- Occupants of other vehicles
No-fault means your own insurance company (not the at-fault driver’s insurer) pays your accident benefits regardless of who caused the accident. This is separate from any tort claim you might pursue against the at-fault driver.
Core Benefits Available Under SABS
Medical and Rehabilitation Benefits:
- Up to $65,000 for non-catastrophic injuries (lifetime)
- Up to $1,000,000 for catastrophic injuries (lifetime)
- Covers physiotherapy, chiropractic, occupational therapy, psychology, attendant care
Income Replacement Benefit (IRB):
- 70% of gross income, up to $400/week (standard; optional enhanced limits available)
- Available if injury prevents you from performing your pre-accident job
- Begins after a 7-day waiting period
Non-Earner Benefit:
- $185/week for those who were not employed at the time of the accident but suffer a complete inability to carry on normal life
- Available after 4-week waiting period
Caregiver Benefit:
- If you were the primary caregiver and cannot provide that care due to injury: up to $250/week for the first dependant, $50/week for each additional dependant
Death and Funeral Benefits:
- Death benefit: up to $25,000 to a spouse and $10,000 to each dependant
- Funeral expenses: up to $6,000
How to Apply
- Notify your insurer within 7 days of the accident (or as soon as practicable). Failure to notify promptly can affect your claim.
- Request the OCF-1 application form (Application for Accident Benefits) from your insurer and return it within 30 days of the accident.
- Complete the Treatment and Assessment Plans (OCF-18 or OCF-23) with your treatment providers — these must be submitted to the insurer before treatments over certain dollar amounts are covered.
- Apply for IRB if you are off work — requires your employer and physician to complete the relevant OCF forms.
What Most People Don’t Know
- Pedestrians and cyclists claim through any Ontario auto insurer. If you are hit as a pedestrian or cyclist, you claim accident benefits through your own auto insurance (if you own a vehicle) or through an occupant of the vehicle involved, or the Motor Vehicle Accident Claims Fund (MVACF) if the vehicle was uninsured or unknown.
- There are strict form deadlines. The OCF-1 must be returned within 30 days of the accident. Treatment plan forms must be submitted before treatment begins (for amounts above the pre-approved framework). Missing deadlines can reduce or eliminate benefits.
- Catastrophic designation dramatically increases your entitlement. If your injury is designated “catastrophic” (which has a specific legal definition including severe brain injuries, spinal cord injuries, and other conditions), your medical/rehab benefits jump from $65,000 to $1,000,000 lifetime and attendant care limits increase substantially.
- You can dispute insurer decisions through FSRA and LAT. If your insurer denies or reduces accident benefits, you can dispute through the Licence Appeal Tribunal (LAT) — a faster alternative to court for accident benefits disputes.
Frequently Asked Questions
My insurer approved $3,500 in physiotherapy and it ran out. Can I get more?
Yes — for non-catastrophic injuries, you can apply for additional medical/rehabilitation benefits beyond the initial pre-approved amounts. Your treatment provider submits an OCF-18 (Treatment and Assessment Plan) detailing the need for additional treatment; the insurer must respond within 10 business days.
I was a passenger in the at-fault driver’s vehicle. Do I still get accident benefits?
Yes — passengers are always entitled to accident benefits from the vehicle owner’s insurer (or your own, if you have one). Fault does not matter for accident benefits. You may also be able to sue the at-fault driver in tort separately from your accident benefits claim.
My injury is preventing me from working, but my income was irregular (self-employed). How is the IRB calculated?
For self-employed individuals, IRB is based on your income tax return for the year prior to the accident (net self-employment income). If income varied, an average of the prior three years may be used. Gather tax records before applying.
The insurer’s medical assessor says I can return to work but my own doctor disagrees. What happens?
Insurers can conduct Independent Medical Examinations (IMEs) to assess your injury. If the IME conflicts with your treating physician’s opinion, you can request an assessment by your own health care provider and dispute the insurer’s decision at the LAT. IME assessors hired by insurers are not neutral parties — obtain your own medical evidence.