The Statutory Accident Benefits Schedule (O. Reg. 34/10) governs the no-fault insurance benefits available to anyone injured in an Ontario motor vehicle accident. Benefits are paid by your own auto insurer regardless of who caused the accident. The SABS sets out every benefit type, its monetary limit, eligibility criteria, and the process for obtaining it.
For non-catastrophically injured claimants, SABS provides a combined pool of up to $65,000 for medical, rehabilitation, and attendant care benefits. This covers physiotherapy, chiropractic care, psychological counselling, occupational therapy, prescription medications, and approved medical devices. For catastrophically designated claimants, this limit rises to $1,000,000.
How benefits are accessed: Most treatments require a pre-approved Treatment and Assessment Plan (OCF-18) submitted by your healthcare provider. Insurers have 10 business days to approve or deny. Failure to respond results in deemed approval.
Claimants unable to perform their pre-accident employment duties are entitled to 70% of gross weekly income, up to $400 per week under standard coverage. Optional enhanced coverage can raise this to $1,000 per week.
For claimants without employment income — students, homemakers, retirees under 65 — the non-earner benefit provides $185 per week after a 26-week waiting period, subject to a demanding “complete inability to carry on a normal life” standard.
Where injuries require personal care assistance, attendant care benefits of up to $3,000/month (non-catastrophic) or $6,000/month (catastrophic) are available. A Form 1 assessment by an occupational therapist or registered nurse establishes the monthly amount.
If you were a primary caregiver for a dependent before the accident and can no longer perform those duties, caregiver benefits are available for catastrophic claimants and through optional coverage for others.
Where a person dies as a result of an Ontario motor vehicle accident, SABS provides a $25,000 death benefit to the surviving spouse and $10,000 to each dependent, plus funeral expenses up to $6,000.
When an Ontario auto insurer denies, reduces, or terminates accident benefits, the claimant has the right to dispute that decision through the Financial Services Regulatory Authority of Ontario (FSRA). The dispute resolution system has two mandatory stages: mediation, followed by arbitration or court action if mediation fails.
Before commencing arbitration, most accident benefits disputes require mandatory FSRA mediation. The FSRA assigns a mediator who facilitates a structured settlement conference. Mediation is informal and non-binding. If it resolves the dispute, the matter ends. If it fails, the mediator issues a report confirming breakdown, opening the pathway to arbitration or court.
Limitation period warning: You have two years from the insurer’s written refusal to dispute a benefit. Once a failed mediation report issues, you have 90 days to commence arbitration (or two years for court). These deadlines are strict — missing them permanently bars the claim.
FSRA arbitration is a formal quasi-judicial hearing before a FSRA arbitrator. Rules of procedure govern document exchange, expert reports, witness examination, and conduct. Arbitrators can order benefits paid, award interest on delayed amounts, and award expenses against parties whose conduct warrants it. Decisions are binding but appealable to the Director’s Delegate and Divisional Court.
A claimant may elect to bring their accident benefits dispute to the Ontario Superior Court of Justice rather than FSRA arbitration. Court is often preferable for high-value claims, disputes where punitive damages are sought, or where legal complexity favours court procedure. Your lawyer will advise which forum best serves your interests.
Income replacement benefits (IRBs) are available to accident claimants who were employed at the time of the accident — as an employee or self-employed — and are substantially unable to perform the essential duties of their pre-accident job due to injuries. Students within 26 weeks of commencing employment in their field may also qualify.
During the first 104 weeks, the test is whether the claimant is substantially unable to perform the essential tasks of their own pre-accident employment. After 104 weeks, the test shifts: whether substantially unable to perform the essential tasks of any employment for which reasonably qualified — a stricter standard mirroring the LTD “any occupation” definition.
Self-employed claimants: Gross weekly income for self-employed persons is calculated using net income reported to the CRA in the 52 weeks before the accident. Undeclared income is not recoverable. Accurate income tax filings are genuinely important for self-employed accident claimants.
The IRB equals 70% of average gross weekly employment income from all sources during the 52 weeks prior to the accident, subject to the applicable weekly maximum ($400 standard; up to $1,000 with optional coverage). Part-time, seasonal, and recently hired workers have specialized calculation methods under the SABS.
Insurers terminate IRBs prematurely in recognizable patterns: using the 104-week definition change without adequate reassessment; file-review medical opinions without examining the claimant; disputes over pre-accident earnings; and incorrect calculation methods for self-employed individuals. Each is challengeable at FSRA or through the courts.
Attendant care benefits under Ontario’s SABS compensate injured claimants for the cost of assistance with personal care and daily living activities made necessary by accident injuries. Covered activities include personal hygiene, mobility assistance, meal preparation, medication management, accompaniment to appointments, and supervision for those with cognitive or behavioural impairments.
The monthly attendant care amount is established by a Form 1 — Assessment of Attendant Care Needs, completed by a registered occupational therapist or registered nurse. The Form 1 categorizes required care into: general personal care; routine health care; and supportive care. Hours required in each category, multiplied by prescribed rates, produce the monthly benefit quantum. Form 1 quality directly affects benefit amounts.
Standard vs. catastrophic limits: Non-catastrophic claimants receive up to $3,000/month; catastrophically designated claimants receive up to $6,000/month. CAT designation therefore dramatically increases attendant care entitlement.
A family member who provides attendant care is entitled to compensation — but only where they have actually incurred an economic loss. This means the family member must have reduced work hours or left employment to provide care. Compensation is the lesser of the Form 1 calculated amount and the actual economic loss incurred.
Insurers frequently dispute attendant care by arguing the Form 1 overstates needs, publicly funded programs are available, or care needs have diminished. A well-supported Form 1 from an experienced occupational therapist, corroborated by treating physician documentation of ongoing functional limitations, is your primary defence against these reductions.
Ontario’s mandatory minimum accident benefits — $65,000 combined medical/rehab/attendant care; $400/week income replacement; $3,000/month attendant care — appear reasonable in isolation. In the context of a serious injury requiring two or more years of intensive rehabilitation, specialist care, and personal support, these limits are inadequate. Most seriously injured Ontarians discover this gap only after benefits are exhausted.
Ontario’s Insurance Act allows policyholders to purchase optional enhanced accident benefits at modest premium increases: increased income replacement (from $400 to $1,000/week); increased medical and rehabilitation benefits (from $65,000 to $1,000,000); increased attendant care (from $36,000 aggregate to $1,000,000 — for non-catastrophic injuries); and optional caregiver, housekeeping, and dependent care benefits.
The premium perspective: Increasing income replacement from $400 to $1,000/week typically costs less than $15/month in additional premium. Increasing medical and rehabilitation benefits to $1 million typically costs under $30/month. These are among the most cost-effective insurance purchases available to Ontario drivers.
For non-catastrophic injuries, the standard $65,000 medical and rehabilitation pool can be exhausted in 18–24 months of active treatment for a seriously injured claimant. Optional OPCF 47 coverage increasing this to $1 million provides catastrophic-level benefits for a fraction of the premium difference. If you review nothing else about your auto policy, review this option.
Under Ontario’s SABS, the primary mechanism for accessing medical and rehabilitation benefits is the Treatment and Assessment Plan (OCF-18). Your healthcare provider submits an OCF-18 to your insurer describing the proposed treatment, its duration, frequency, and estimated cost. The insurer must then approve or deny within a prescribed timeframe.
For most treatment plans, the insurer has 10 business days from receipt to respond. Emergency treatment — where delay would jeopardize health or recovery — must receive a response within three business days. Where the insurer fails to respond within the applicable window without seeking an extension, the treatment plan is deemed approved under the SABS. Deemed approval is a powerful tool in cases where insurers are stalling.
Pre-approval requirement: Most treatment and rehabilitation services require pre-approval before costs are incurred. Proceeding with treatment before an OCF-18 is approved (absent an emergency) risks non-reimbursement. Ensure your healthcare providers understand the pre-approval requirement and submit OCF-18 forms promptly and completely.
Insurers deny OCF-18s on various grounds: the treatment is not reasonable and necessary for injuries sustained; the claimant is in the MIG and the proposed treatment exceeds the $3,500 cap; the proposed provider is not authorized under the SABS; or cost exceeds the applicable fee schedule. Each ground is disputable at FSRA mediation and arbitration.
Insurers must provide section 38 notices when they refuse or reduce proposed treatments. A valid section 38 notice starts the limitation period running on the disputed benefit. Understanding when notice was received and what it addresses is critical to timely dispute filing — another reason why legal involvement from the outset of a significant claim is important.
Not every accident claimant was employed at the time of their accident. Students, full-time homemakers, retirees under 65, and others without employment income are excluded from the income replacement benefit regime. The non-earner benefit exists specifically for this population. It provides a fixed weekly benefit of $185 payable after a 26-week waiting period, regardless of pre-accident income or activities.
The non-earner benefit is available only to claimants who suffer a complete inability to carry on a normal life as a result of their accident injuries. This standard is demanding and goes beyond mere difficulty with daily activities. Courts and arbitrators have interpreted it to require that injuries fundamentally alter the pattern of the claimant’s entire life — not merely create inconvenience in some areas. Comprehensive medical evidence documenting functional limitations across all domains of daily activity is essential.
The 26-week waiting period: The non-earner benefit does not begin until 26 weeks after the accident. During those 26 weeks, the claimant has access to the medical and rehabilitation benefit pool but no weekly income replacement. Planning for this gap through household budget adjustments is important in the post-accident period.
Students within 26 weeks of commencing employment in their field of study at the time of the accident may qualify for the income replacement benefit rather than the non-earner benefit — explore that avenue first. Students who do not meet this requirement may access the non-earner benefit, and the functional impact on academic performance and future career trajectory should be fully documented for both the non-earner claim and any eventual tort claim.
Ontario’s SABS provides benefits for the cost of housekeeping and home maintenance activities that an injured claimant performed before the accident and can no longer perform — or can no longer perform to the same extent — as a result of injuries. Covered activities include interior housekeeping, laundry, cooking, shopping, lawn and garden maintenance, snow removal, and standard household upkeep tasks the claimant performed without assistance prior to the accident.
Under the standard SABS benefit structure, housekeeping and home maintenance benefits are available only to catastrophically injured claimants. For non-catastrophic injuries, these benefits must be purchased as optional coverage (OPCF 43) before the accident. Many claimants with serious but non-catastrophic injuries discover too late that they have no SABS entitlement to housekeeping compensation.
Maximum benefit: The SABS housekeeping and home maintenance benefit is capped at $100 per week. While modest, it provides meaningful assistance over a multi-year recovery and should not be overlooked. Where the claimant employed a professional housekeeper before the accident, the cost of a replacement service is recoverable in the tort claim as an economic loss independent of SABS.
To access housekeeping benefits, the claimant must demonstrate through medical evidence that injuries prevent them from performing specific household tasks they formerly performed. Receipts for housekeeping services engaged since the accident, combined with a treating occupational therapist’s functional assessment confirming limitations, provide the strongest evidentiary foundation for these benefits.
The death of a family member in a motor vehicle accident triggers entitlements under two separate legal frameworks: accident benefits under the SABS, providing immediate financial support to surviving family members; and a potential tort claim against the at-fault driver, advancing both the deceased’s estate’s claims and the independent Family Law Act claims of qualifying family members. Both tracks must be pursued simultaneously.
Ontario’s SABS provides three financial benefits following a fatal accident. First, the death benefit: $25,000 to the surviving spouse (or person most responsible for the deceased’s care if no spouse); and $10,000 to each of the deceased’s dependants. Second, funeral and burial expense benefits of up to $6,000. Third, grief counselling benefits of up to $400 per person per week for the spouse and each dependant for up to 26 weeks.
Optional death benefits: Standard SABS death benefit amounts are modest relative to the actual financial impact of wrongful death on a surviving family. Optional enhanced death benefit coverage purchased before the accident can substantially increase these amounts. Review your policy’s optional coverage elections with a lawyer.
Where another person’s negligence caused the fatal accident, both the deceased’s estate and qualifying family members may pursue tort damages. The estate may recover the deceased’s pain and suffering from the moment of accident to death, and any income loss in that period. Under Part V of the Family Law Act, each qualifying family member — spouse, child, parent, grandparent, grandchild, sibling — may independently claim for funeral expenses, loss of income and services, and damages for loss of care, guidance, and companionship.
Fatal accident cases involve complex interplay between SABS entitlements, estate law, and FLA claims — each with its own deadlines and procedural requirements. Grief does not suspend limitation periods. Retaining an experienced personal injury lawyer promptly after a fatal accident ensures every available source of compensation is identified and pursued, and that all applicable deadlines are met.