Ontario Accident Benefits After the July 2026 Reforms

What changed on 1 July 2026

O. Reg. 383/24 amended the SABS so that certain benefits are offered as options rather than as part of every policy. Most of its provisions came into force on July 1, 2026. The change is tied to the policy: the optional-benefit rules apply to motor vehicle liability policies that are new or renewed from that date (s. 2(1.0.1) of the SABS). Which version of a rule applies to a particular claim depends on the policy date, the accident date, or both, and should be confirmed with a lawyer.

Two points follow from the text:

• Optional benefits apply if purchased. The regulation says each optional benefit may be bought at any time before the accident, and that the insurer issues an endorsement when one is bought. When a policy renews from July 1, 2026, the earlier benefits are treated as continuing as optional benefits in the same amounts unless the named insured and insurer agree in writing to decline or change them (s. 2(1.0.2)).
• Optional benefits are limited to four groups: the named insured, the spouse of the named insured, the dependants of the named insured and spouse, and persons listed on the policy as drivers (s. 2(1.0.4)). A person outside those groups, such as a pedestrian injured by an insured vehicle, is not within the optional benefits. What that person can claim, and from which insurer, depends on the facts and the priority rules in the Insurance Act, and should be confirmed with a lawyer.

A separate change applies by accident date. For Ontario accidents from July 1, 2026 onward, medical and rehabilitation benefits (other than medication) are payable for the part of an expense that a supplementary health insurance plan, such as an employer group plan or an individual plan, would reasonably cover (s. 47(2.1)). For other plans or laws, the general rule in s. 47(2) is that the insurer is not required to pay the part of an expense that is reasonably available elsewhere.

The deadlines

The Schedule bars an application to the Licence Appeal Tribunal where the person did not give notice or submit an application within the times it prescribes (s. 55(1)). Separately, s. 34 says that missing a time limit set in Part VIII of the Schedule does not by itself end entitlement where the person has a reasonable explanation for the delay. Where notice is late without a reasonable explanation, s. 32(10) lets the insurer delay deciding entitlement and paying until the later of two dates tied to the completed application and to information requests. How s. 32(10), s. 34 and s. 55 apply to a particular delay depends on the facts and should be confirmed with a lawyer. Benefits under the Schedule are paid by the insurer that is liable under s. 268(2) of the Insurance Act (s. 2(4) of the SABS).

The benefits, in detail

The monetary limits below are those in the saved SABS text, which is the version current to October 6, 2026. Amounts are as they appear in that text on its date, so check for later changes. Where the text ties a figure to an accident date, that date is shown.

Medical and rehabilitation. These benefits pay for expenses that are reasonable, necessary and caused by the accident, within the categories set out in ss. 15 and 16, such as treatment, assessments and rehabilitation. They are subject to the monetary limits in s. 18.

• Minor injury limit: $3,500. When the impairment is predominantly a minor injury, s. 18(1) sets a ceiling of $3,500 per accident on medical and rehabilitation benefits together (plus HST where the accident was on or after June 3, 2019), reduced by amounts already paid under the Minor Injury Guideline. The Schedule defines "minor injury" through a short list of soft-tissue type injuries and their clinically associated sequelae (s. 3(1)); the MIG guide walks through that definition.
• Not subject to the minor injury limit: $65,000. For a person outside the minor injury limit, s. 18(3)(a) caps medical, rehabilitation and attendant care benefits combined at $65,000 for any one accident (HST is added for accidents from June 3, 2019). The text provides that this limit applies unless modified by optional medical, rehabilitation and attendant care benefits (s. 18(4)); the Schedule describes optional amounts of $130,000 (non-catastrophic), $1,000,000 or $2,000,000 (depending on catastrophic status) and $1,000,000 (catastrophic) in s. 28(1), paras. 3 to 5.
• Catastrophic impairment: $1,000,000. For a person who sustained a catastrophic impairment, the combined limit is $1,000,000 (HST is added for accidents from June 3, 2019) under s. 18(3)(b).
• Time limit. For a person aged 18 or over when the accident happened, medical, rehabilitation and attendant care expenses are not payable if incurred more than 260 weeks (five years) after the accident; for a person under 18, they are not payable after the 28th birthday. These time limits do not apply to a person with a catastrophic impairment, or to a person entitled to the optional benefits in s. 28(1), paras. 4 and 5 (s. 20(2)).

Attendant care. Attendant care benefits pay for reasonable, necessary expenses of care by an aide, an attendant or a long-term care facility (s. 19(1)). The monthly amount is worked out from the "Assessment of Attendant Care Needs" document and hourly rates set under the Guidelines (s. 19(2)). Absent the optional higher benefits, the monthly cap is $3,000 for a non-catastrophic impairment and $6,000 for a catastrophic impairment, with HST added for accidents from June 3, 2019 (s. 19(3)). Under s. 14, attendant care is tied to impairments other than minor injuries.

Income replacement (optional). If the benefit is in place, the insurer pays it to an insured person who, because of the accident and within 104 weeks, has a substantial inability to carry out the essential tasks of the job held when the accident happened, or meets the alternative conditions for people not employed or self-employed (s. 5). The weekly base amount in the first 104 weeks is 70 per cent of gross weekly income, and the weekly amount paid is the lesser of that figure (less other income replacement assistance) and the amount fixed by the optional benefit (s. 7). Nothing is payable for the first week of disability. After the first 104 weeks the test changes to a complete inability to hold any job or self-employment that fits the person's education, training and experience (s. 6(2)). The dollar maximum depends on the optional benefit that was purchased.

Non-earner (optional). Payable to an insured person with a complete inability, as defined in s. 3(7), to carry on a normal life arising within 104 weeks, who does not qualify for income replacement, or who was a full-time student or recent graduate in the circumstances described in s. 12(1). It is not payable for the first four weeks, before age 18, or beyond 104 weeks from the accident (s. 12(3)).

Caregiver (optional). Payable where, within 104 weeks, the insured person is substantially unable to continue the caregiving the person was doing at the time of the accident, and meets the other conditions in s. 13.

Housekeeping and home maintenance (optional). Covers reasonable, necessary extra housekeeping and home maintenance costs, to the dollar amount set by the optional benefit purchased (s. 23(1)). Unless the impairment is catastrophic, costs incurred beyond 104 weeks from the onset of disability are not covered (s. 23(2)).

Death and funeral (optional). The death benefit is payable where the insured person dies as a result of the accident within 180 days, or within 156 weeks if continuously disabled, with payments to a spouse, dependants and others listed in s. 26(2) in amounts set by the optional benefit. The funeral benefit pays funeral costs up to a ceiling set the same way (s. 27(2)).

The Minor Injury Guideline fight

Section 18(1) applies when a minor injury predominates. The Schedule contains two exceptions: a health practitioner's statement that a minor injury does not predominate (s. 38(3)), and compelling evidence of a pre-existing condition documented before the accident (s. 18(2)). Both depend on medical evidence. The separate guide on escaping the MIG covers both exceptions in more detail.

Catastrophic impairment

Catastrophic impairment status raises the combined medical, rehabilitation and attendant care limit to $1,000,000 for any one accident (accident on or after June 3, 2019 for the HST addition) and lifts the time limit in s. 20(1). The definition in s. 3.1(1) applies to impairments sustained in accidents on or after June 1, 2016. It lists categories that include paraplegia or tetraplegia meeting stated criteria, severe loss of walking ability or arm use, or amputation; loss of vision in both eyes meeting stated criteria; a traumatic brain injury meeting stated criteria; 55 per cent or more whole person impairment under the AMA Guides (4th edition); and certain mental or behavioural impairments. For the 55 per cent and mental or behavioural categories, s. 3.1(2) and (3) add timing conditions, such as two years since the accident or a physician's assessment.

The Schedule lets an insured person ask the insurer to decide whether an impairment is catastrophic; the assessment is done by a physician, or by a neuropsychologist when the only impairment is a brain injury (s. 45). The combined limit is $65,000 without the status and $1,000,000 with it, unless modified by optional benefits.

When benefits are denied

When an insurer refuses a benefit or reduces one a person is receiving, the Schedule requires it to give written notice of the right to dispute (s. 54). A dispute about entitlement to, or the amount of, accident benefits is resolved by the Licence Appeal Tribunal, and the Insurance Act limits court proceedings on those disputes to an appeal or judicial review of a Tribunal decision (s. 280(1) to (3)). Key points from the text:

• An application is made under s. 280(2) of the Insurance Act, and SABS s. 56 gives two years counted from the refusal. How the period applies where there are several refusals depends on the facts and should be confirmed with a lawyer.
• The Schedule restricts applications where notice or an application was not made within the prescribed times, or where a required insurer examination was not attended (s. 55(1)); the Tribunal may permit an application in some of those cases (s. 55(2)).
• Procedural rules of the Tribunal are not covered in this article.

How this fits with a lawsuit

Accident benefits are defined by the Schedule and have limits. A claim against an at-fault party in court is a separate matter and is subject to the Insurance Act, including the limits on recovery for income loss and health care expenses and the threshold for non-pecuniary damages in s. 267.5.

Where both apply, s. 267.8 reduces certain damages by amounts received or available as statutory accident benefits, including for income loss and for health care expenses. See what your claim is worth.