If you are in Ontario on a work permit or study permit and you have been hurt in a car accident, you may be worried about two things at once: getting the care and compensation you need, and whether making a claim could affect your immigration status. These worries are understandable, especially when you are new to the province.
The reassuring general picture is this: in Ontario, your immigration status usually does not take away your right to accident benefits or your right to sue an at-fault driver. This guide explains how those rights generally work for newcomers, how the July 2026 accident-benefit changes may affect you, and why combined injury and immigration advice can be valuable. It is general information, not legal advice.
Your immigration status usually does not take away your right to accident benefits or your right to sue an at-fault driver. Ontario’s auto-insurance and injury rules focus on the accident and the people involved, not on a person’s citizenship or immigration status.
Key takeaways
Immigration status generally does not bar a newcomer from claiming accident benefits or from suing an at-fault driver after an Ontario car crash.
Accident benefits typically flow from the household auto policy first, then the at-fault vehicle’s insurer, and in some cases the Motor Vehicle Accident Claims Fund.
As of July 1, 2026, most Ontario accident benefits became optional under Ontario Regulation 383/24 — which can leave newcomers with fewer automatic benefits if no one opted in.
Making an injury claim is generally a civil matter and is not the same as an immigration process — but because both areas interact, getting advice on both together is wise.
You can usually ask for an interpreter so language is not a barrier to understanding your rights.
Do newcomers have the same accident rights?
In general, Ontario’s auto-insurance and injury rules focus on the accident and the people involved, not on a person’s citizenship or immigration status. A temporary resident — someone on a work permit, study permit, or other temporary status — who is injured in a car accident in Ontario generally has access to the same two-track system as anyone else:
Accident benefits (also called SABS benefits): no-fault benefits that can help with medical care, rehabilitation, and, in some situations, other losses, regardless of who caused the crash.
A tort claim: a lawsuit against the at-fault driver for losses the benefits do not fully cover, such as pain and suffering and income loss, subject to Ontario’s rules.
Your status as a newcomer does not, on its own, remove these rights. What can change is how much is covered automatically, which is where the 2026 changes come in.
Where do the benefits come from?
Injured people sometimes assume they need their own car or their own policy to claim. That is often not the case. Accident benefits generally follow an order of priority. For many newcomers, benefits may be available even if they do not personally own a car.
If you…
Benefits generally come from…
Live in a household with an auto policy
That household auto policy is usually the first place to look
Have no household auto policy but were struck by an insured vehicle
The at-fault or striking vehicle’s insurer may respond
Were hurt in a crash with no identified or insured vehicle
The Motor Vehicle Accident Claims Fund (MVACF) may be a last resort
Because these priority rules can be complicated — and depend on the facts of your situation — it is often worth getting advice on which insurer should be paying.
How the July 2026 changes affect newcomers
Effective July 1, 2026, Ontario’s standard auto policy changed under Ontario Regulation 383/24 so that most statutory accident benefits became optional. This matters a great deal for newcomers.
Under the reform:
Still mandatory (always included): medical, rehabilitation, and attendant care benefits.
Now optional (must be purchased or opted into in writing): income replacement, non-earner, caregiver, housekeeping and home maintenance, lost educational expenses, visitor expenses, damage to personal items such as clothing and eyewear, death and funeral benefits, and dependant care.
The change is opt-in, not opt-out: renewing policies keep their pre-July-2026 coverage until the consumer agrees in writing to reduce it. But if you are relying on someone else’s policy — for example, a household member’s — the benefits available to you depend on what that policyholder has chosen.
The reform also narrowed eligibility for optional benefits. Generally, optional benefits are available only to the named insured, their spouse, their dependants, and listed drivers. Pedestrians, cyclists, and some passengers who previously had access may no longer qualify for those optional benefits. A newcomer who does not have their own policy and is not a listed driver could find fewer benefits available than they might have expected before July 2026.
Because income replacement is now optional, more of that loss may need to be pursued through a tort claim against the at-fault driver. Commentators expect more lawsuits as a result. For newcomers whose income supports family here or abroad, this shift can be significant.
Will making a claim affect my status?
Many newcomers hesitate to claim because they fear it could harm their immigration status. In general, pursuing an accident-benefits claim or a personal-injury lawsuit is a civil matter, separate from your immigration file, and does not by itself change your status. Seeking the compensation the law provides is your right.
Pursuing an accident-benefits claim or a personal-injury lawsuit is a civil matter, separate from your immigration file, and does not by itself change your status. Seeking the compensation the law provides is your right.
That said, injury and immigration issues can intersect in practical ways — for example, if an injury affects your ability to keep working or studying on the terms of your permit, or if your recovery timeline overlaps with a permit expiry. That is exactly why getting combined injury and immigration advice is valuable: so the two sides of your situation are handled together, not in isolation.
Language and interpreter access
You should not have to give up your rights because English is not your first language. In dealings with insurers, medical assessors, and lawyers, you can generally ask for an interpreter or bring someone to help you understand. A good legal team will make sure you understand each step and that your account is accurately recorded.
Practical steps after a crash
Get medical attention and keep records of your injuries and treatment.
Report the accident and get the other driver’s insurance and vehicle information if you safely can.
Find out whether there is an auto policy in your household and what benefits it includes after July 2026.
Note that a tort claim in Ontario generally must be started within two years — deadlines matter.
Consider advice that covers both your injury claim and any immigration questions together.
Frequently asked questions
I am on a work permit and don’t own a car. Can I still claim accident benefits?
Often yes. Accident benefits generally follow a priority order that can include a household auto policy or the at-fault vehicle’s insurer, so you may have access even without your own policy. The exact answer depends on your circumstances, so it is worth confirming with advice.
Could making an injury claim hurt my immigration application?
In general, an injury claim is a civil matter and does not by itself affect your status. Because injury and immigration issues can overlap in practice, however, it is sensible to get advice on both together rather than assume there is no connection.
How did July 2026 change things for newcomers specifically?
As of July 1, 2026, most accident benefits became optional, and optional benefits are generally limited to the named insured, spouse, dependants, and listed drivers. A newcomer relying on someone else’s policy — or not covered by one — may find fewer benefits available and may need to look to a tort claim against the at-fault driver.
What if I do not speak English well?
You can generally request an interpreter when dealing with insurers, assessors, and lawyers. Language should not stop you from understanding or exercising your rights.
If you are a newcomer injured in an Ontario car accident and you are unsure about your benefits, a possible lawsuit, or how any of it interacts with your permit, you do not have to sort it out alone. Azimi Law handles both personal-injury and immigration matters and can talk with you about how they fit together in your situation. You are welcome to reach out; there is no obligation and no guarantee of any particular outcome.
New to Ontario and hurt in a crash?
Get a clear, plain-language read on your accident benefits and how they fit with your immigration situation.
This article is general legal information, not legal advice, and does not create a lawyer–client relationship. Laws, benefit amounts, deadlines, and government policies change and depend on your specific circumstances. Please confirm current details with the official source or contact Azimi Law for advice about your situation.
If you were walking or cycling when a car struck you, you may assume Ontario’s auto-insurance system will cover the same benefits it always has. As of July 1, 2026, that assumption needs a second look. New rules narrow who can access certain accident benefits, and pedestrians and cyclists are among the people most likely to feel the gap.
This guide explains how an injured pedestrian or cyclist normally claims after being hit by a vehicle, what changed in 2026, and why a claim against the at-fault driver has become more important. It is general information to help you understand your options, not advice about your specific situation.
How pedestrians and cyclists usually claim after being struck
In Ontario, if you are hit by a car while walking or riding a bicycle, you generally have more than one possible source of compensation. Two systems can apply at the same time:
Statutory accident benefits (no-fault benefits). These are paid regardless of who caused the crash. They can cover things like medical treatment, rehabilitation, and attendant care.
A tort claim against the at-fault driver. This is a lawsuit for damages such as pain and suffering and, in many cases, income loss, brought against the person who caused the collision.
For accident benefits, there is usually an order to figure out which insurer responds. Generally, an injured pedestrian or cyclist looks first to an auto policy in their own household (for example, their own policy or that of a spouse or family member they live with). If no such policy exists, they may claim through the insurer of the vehicle that struck them. If there is no accessible auto insurance at all, the Motor Vehicle Accident Claims Fund (MVACF), Ontario’s fund of last resort, may be available. The exact order depends on the facts, so this is an area where early advice matters.
What changed on July 1, 2026
Under Ontario Regulation 383/24, the standard auto policy changed so that most statutory accident benefits became optional as of July 1, 2026. A few core benefits stay mandatory and are always included, while a longer list of benefits must now be purchased or opted into in writing.
Still mandatory (always included)
Now optional (must be bought / opted into in writing)
Medical benefits
Rehabilitation benefits
Attendant care benefits
Income replacement
Non-earner
Caregiver
Housekeeping and home maintenance
Lost educational expenses
Visitor expenses
Damage to personal items (clothing, eyewear)
Death and funeral benefits
Dependant care
The change is opt-in, not opt-out. Renewing policies keep the coverage that existed before July 2026 until the consumer agrees in writing to reduce it. The ability to choose optional benefits is available to all consumers from July 1, 2026, regardless of when their policy renews.
Why this matters especially for pedestrians and cyclists
Along with making benefits optional, the reform narrowed who can access those optional benefits. Generally, the optional benefits are available only to the named insured on a policy, their spouse, their dependants, and listed drivers. Because pedestrians and cyclists are, by definition, not driving the car that hit them, some of them fall outside this narrower group.
Someone without their own household auto policy is particularly exposed, because they may have relied on the at-fault vehicle’s insurer for benefits that are no longer automatic and that may not extend to them.
In practical terms, a pedestrian or cyclist who previously could reach into a striking vehicle’s optional coverage may find that fewer benefits are available now. Someone without their own household auto policy is particularly exposed, because they may have relied on the at-fault vehicle’s insurer for benefits that are no longer automatic and that may not extend to them.
The mandatory benefits (medical, rehabilitation, and attendant care) are still there. The gap tends to appear with benefits like income replacement, caregiver, and housekeeping, which many injured people depend on to get through recovery.
The growing importance of the tort claim
When benefits like income loss are no longer automatic through accident benefits, more of those losses must be pursued through the tort claim against the at-fault driver. Commentators expect this shift to lead to more lawsuits. For an injured pedestrian or cyclist, this means the case against the driver who caused the collision may carry more weight than it did before, because it may be the main route to recovering income loss and other heads of damage that used to be covered by benefits.
Key takeaways
Medical, rehabilitation, and attendant care benefits remain mandatory after July 1, 2026.
Many other benefits (including income replacement, caregiver, and housekeeping) are now optional and must be purchased or opted into in writing.
Optional benefits are generally limited to the named insured, spouse, dependants, and listed drivers, so pedestrians and cyclists may have less access than before.
Injured pedestrians and cyclists generally look to a household auto policy first, then the striking vehicle’s insurer, then the MVACF.
With fewer automatic benefits, a tort claim against the at-fault driver may be more central to being made whole.
Practical steps after being struck by a vehicle
Get medical care and keep it going. Your health comes first, and consistent medical records also document your injuries.
Call the police and get a report. An official record of the collision helps establish what happened and who was involved.
Collect information at the scene if you can. This includes the driver’s name, licence plate, and insurance details, plus the names of any witnesses.
Take photos. Photograph the scene, the vehicle, your injuries, and any damaged personal items such as a bicycle, helmet, or clothing.
Report the accident. Notify the relevant auto insurer promptly. Accident-benefit claims have deadlines to apply.
Check your own coverage. Find out whether you or a household member has an auto policy and what optional benefits were selected.
Get advice early. Because the 2026 rules changed who can access which benefits, understanding your options sooner rather than later can help.
Report the accident promptly. Accident-benefit claims have deadlines to apply, so notify the relevant auto insurer without delay.
Frequently asked questions
I do not own a car. Can I still get accident benefits if a vehicle hits me?
Generally, yes, you may still be able to access accident benefits even without your own vehicle. The usual approach is to look first to an auto policy in your household, then to the insurer of the vehicle that struck you, and finally to the Motor Vehicle Accident Claims Fund if no other coverage is available. The mandatory benefits (medical, rehabilitation, and attendant care) remain in place. Which insurer responds and which optional benefits apply depends on your circumstances.
Did the July 2026 changes take away my right to any benefits at all?
No. Medical, rehabilitation, and attendant care benefits are still mandatory and included in every policy. What changed is that many other benefits became optional, and access to those optional benefits was narrowed. That is why some pedestrians and cyclists may find fewer benefits available than before July 1, 2026.
Can I sue the driver who hit me?
In many cases, an injured pedestrian or cyclist can bring a tort claim against the at-fault driver for damages such as pain and suffering and income loss, subject to Ontario’s rules for auto injury claims. With several benefits no longer automatic, this claim has become more important as a way to recover losses. Whether and how to proceed depends on the facts of your case.
How do I know what optional benefits apply to me?
Optional benefits are generally available to the named insured, their spouse, their dependants, and listed drivers on a policy. If you were struck as a pedestrian or cyclist, whether you can access a given optional benefit depends on the policies involved and your relationship to them. Reviewing the applicable policies, or asking a lawyer or broker to help, can clarify what is available.
The 2026 changes can make it harder to tell which benefits apply after a pedestrian or cyclist is hit by a car. If you or a loved one was injured this way, Azimi Law can review your circumstances and explain the options that may be open to you. There is no pressure and no promise of a particular outcome, just clear information about where you stand. You are welcome to reach out to discuss your situation.
Struck by a car while walking or cycling?
The 2026 rules changed who can access which benefits. Get a clear, plain-language read on your options.
This article is general legal information, not legal advice, and does not create a lawyer–client relationship. Laws, benefit amounts, deadlines, and government policies change and depend on your specific circumstances. Please confirm current details with the official source or contact Azimi Law for advice about your situation.
If you drive in Ontario, the accident benefits you count on after a crash are changing. As of July 1, 2026, most of the benefits that used to come automatically with every auto policy are now optional. That means some coverage you once had by default is only there if you buy it.
This guide explains what changed under Ontario Regulation 383/24, which benefits stay mandatory, which are now optional, and why the shift matters if you are injured. It is general information to help you understand the reform and ask your broker the right questions.
This reform affects new and renewing policies from July 1, 2026 onward. If you walk, cycle, or ride as a passenger, your access to certain benefits may have narrowed — see “Who can access the optional benefits” below.
Key takeaways
As of July 1, 2026, most statutory accident benefits in Ontario become optional under O. Reg. 383/24.
Medical, rehabilitation, and attendant care benefits remain mandatory and are always included.
Income replacement, caregiver, housekeeping, and several other benefits must now be purchased.
The change is opt-in, not opt-out: renewing policies keep the old coverage until you agree in writing to reduce it.
With fewer benefits automatic, more losses may need to be pursued through a tort claim against the at-fault driver.
What changed on July 1, 2026
Ontario’s standard auto insurance policy has long bundled a set of statutory accident benefits, known as SABS. These are the no-fault benefits you can claim after a collision regardless of who caused it. The amending regulation, O. Reg. 383/24, restructures that package so that most of those benefits are no longer automatic. Instead, they are offered as optional coverage you can choose to buy.
The reform took effect July 1, 2026. From that date, optionality is available to all consumers regardless of when their policy renews. The core idea is that a smaller mandatory set stays in place, and the rest becomes a menu of add-ons.
Benefits that stay mandatory
Three benefits remain part of every Ontario auto policy and are always included:
Medical benefits — coverage for reasonable and necessary medical treatment related to the accident.
Rehabilitation benefits — coverage for care aimed at restoring function and easing the effects of injury.
Attendant care benefits — coverage for an aide to help with personal care when injuries require it.
If you are seriously hurt, these three are the backbone of your no-fault coverage, and you do not have to buy them separately.
Benefits that are now optional
The following benefits are no longer automatic. To have them, you generally have to purchase them, or opt into them in writing:
Income replacement
Non-earner benefit
Caregiver
Housekeeping and home maintenance
Lost educational expenses
Visitor expenses
Damage to personal items (such as clothing and eyewear)
Death and funeral benefits
Dependant care
Many of these matter most when someone cannot work, cannot care for their family, or dies as a result of a crash. Because they are now optional, a driver who does not buy them may find those cushions missing at the worst possible time.
Mandatory versus optional at a glance
Benefit
Status as of July 1, 2026
Medical
Mandatory (always included)
Rehabilitation
Mandatory (always included)
Attendant care
Mandatory (always included)
Income replacement
Optional (must be purchased)
Non-earner
Optional (must be purchased)
Caregiver
Optional (must be purchased)
Housekeeping and home maintenance
Optional (must be purchased)
Lost educational expenses
Optional (must be purchased)
Visitor expenses
Optional (must be purchased)
Damage to personal items
Optional (must be purchased)
Death and funeral benefits
Optional (must be purchased)
Dependant care
Optional (must be purchased)
Opt-in, not opt-out: why your renewal matters
One of the most important features of the reform is how the choice is structured. This is an opt-in system, not an opt-out one. If your policy renews after July 1, 2026, you generally keep your pre-July-2026 coverage until you agree in writing to reduce it. In other words, no insurer should be quietly stripping benefits from your policy without your written agreement.
Read your renewal paperwork closely. If you sign a form to reduce coverage in exchange for a lower premium, you may be giving up protection you would want after a serious injury. Ask your broker to explain, in plain terms, exactly what you would keep and what you would give up.
Who can access the optional benefits
Eligibility for the optional benefits is also narrower than before. Generally, the optional benefits are available to the named insured, their spouse, their dependants, and listed drivers. As a result, pedestrians, cyclists, and some passengers who previously had access to certain benefits may no longer qualify. If you often walk or cycle, this is an important gap to understand, because you may not be covered under someone else’s optional benefits the way you might expect.
The shift toward tort claims
Ontario’s injury system has two tracks: no-fault accident benefits from your own insurer, and a tort claim against the driver who caused the crash. When benefits like income replacement are no longer automatic, more of those losses may have to be recovered through the tort side instead.
In practice, that can mean more injured people needing to sue the at-fault driver to be made whole for lost income and similar losses. Commentators expect more lawsuits as a result. Keep in mind that tort awards for pain and suffering are also reduced by a statutory deductible that is indexed each year, so the tort track has its own rules and limits. If you want the current deductible figure, you can confirm it with FSRA.
Frequently asked questions
Do I still have medical coverage after a crash in 2026?
Yes. Medical, rehabilitation, and attendant care benefits remain mandatory and are always included in an Ontario auto policy, so this core coverage is not something you have to buy separately.
Will my benefits automatically be cut at renewal?
Generally no. The reform is opt-in, not opt-out. A renewing policy keeps its pre-July-2026 coverage until you agree in writing to reduce it. Read any renewal forms closely before signing anything that lowers your coverage.
I was hurt as a pedestrian. Am I still covered?
It depends. Optional benefits are generally limited to the named insured, spouse, dependants, and listed drivers, so some pedestrians and cyclists may no longer qualify for benefits they once could access. This is a good situation to get individual advice about.
Should I buy the optional benefits?
That is a personal decision based on your income, your family, and your budget, and this article cannot tell you what to choose. Speaking with your broker about your own situation is generally the best starting point.
Have these figures been finalized?
The July 1, 2026 changes come from O. Reg. 383/24, but benefit amounts and thresholds are indexed and can change. Always confirm current details with the official source, FSRA, before relying on a specific number.
If you have been injured in a crash and are unsure which benefits apply to you, or you are trying to make sense of your coverage after the 2026 changes, Azimi Law would be glad to talk through your situation. Reach out for general guidance about your options — there is no pressure and no promises, just a plain-language conversation about where you stand.
Not sure what your policy still covers?
The 2026 accident-benefit changes are significant. Get a clear, plain-language read on your options after an injury.
This article is general legal information, not legal advice, and does not create a lawyer–client relationship. Laws, benefit amounts, deadlines, and government policies change and depend on your specific circumstances. Please confirm current details with the official source or contact Azimi Law for advice about your situation.
What Is the SABS?
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.
Medical and Rehabilitation Benefits
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.
Income Replacement Benefits
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.
Non-Earner Benefits
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.
Attendant Care Benefits
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.
Caregiver and Dependent Care
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.
Death and Funeral Benefits
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.
Your Right to Dispute Denied Benefits
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.
Stage One — FSRA Mediation
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.
Stage Two — FSRA Arbitration
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.
Electing Court Instead
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.
Who Qualifies for Income Replacement Benefits
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.
The Two-Stage Disability Test
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.
Calculating Your IRB
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.
Common IRB Dispute Scenarios
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.
What Attendant Care Benefits Cover
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.
How Benefits Are Quantified — The Form 1 Assessment
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.
Family Members as Attendant Care Providers
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.
Challenging Insurer Reductions
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.
The Gap Between Standard Coverage and Real Injury Costs
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.
Optional Enhanced Benefits Available
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.
The Most Important Enhancement
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.
The OCF-18: Your Gateway to Rehabilitation Funding
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.
The Approval Timeline and Deemed Approval
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.
Common Grounds for OCF-18 Denial
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.
Section 38 Notices
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.
Who the Non-Earner Benefit Is For
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 “Complete Inability” Test
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.
Non-Earner Benefits and Students
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.