Information on Accident Benefits in Ontario on or after September 1, 2010
Every automobile insurance policy in Ontario contains mandatory accident benefits coverage. These benefits are available regardless of who was at fault in the collision. Accident benefits are intended to provide basic but immediate compensation to injured motorists.
Below you will find a comprehensive list of benefits provided for under the Statutory Accident Benefits Scheme (SABS). Entitlement to the various benefits will depend on individual circumstances.
Medical and Rehabilitation Benefits
These benefits are intended to provide immediate access to treatment to help you on your road to recovery. For accidents on or after September 1, 2010, there are three categories of entitlement:
- Minor Injury Guideline which provides up to $3,500 in Med/Rehab Benefits
- Non-Catastrophic designation which provides up to $50,000 in Med/Rehab Benefits
- Catastrophic Injuries which provides up to $1,000,000 in Med/Rehab Benefits
If reasonable and necessary, the insurance company will pay for your associated medical and rehabilitation expenses for the following:
- medical, surgical, dental, optometric, hospital, nursing, ambulance, audiometric and speech-language pathology services;
- chiropractic, psychological, occupational therapy and physiotherapy services;
- social and vocational rehabilitation;
- prescription eyewear;
- dentures and other dental devices;
- hearing aids, wheelchairs or other mobility devices, prostheses, orthotics and other assistive devices;
- transportation for the insured person to and from treatment sessions, including transportation for an aide or attendant if over 50km; and
- other goods and services of a medical nature that the insured person requires, other than goods or services for which a benefit is otherwise provided in the SABS.
Income Replacement Benefits
If you are unable to return to work due to your injuries, you may qualify for income replacement benefits. You may also qualify for this benefit if you had been working most of the year leading up to the collision. This benefit is intended to provide you with weekly assistance while you remain unable to return to work. No income replacement benefits are payable for the first 7 days following an accident.
The amount of this benefit is 70% of your gross income to a maximum of $400 per week. This amount is also subject to deductions of any collateral benefits you may be entitled to receive.
To qualify you must have been employed at the time of the accident and as a result of the accident suffer a substantial inability to perform the essential tasks of that employment.
If you were unemployed at the time of the accident you may still qualify under the following conditions:
- you were employed for at least 26 weeks during the 52 weeks before the accident or were receiving benefits under the Employment Insurance Act (Canada) at the time of the accident;
- you were at least 16 years old or were excused from attending school under the Education Act at the time of the accident; and
- as a result of and within 104 weeks after the accident, you suffer a substantial inability to perform the essential tasks of the employment in which you spent the most time during the 52 weeks before the accident
There are also similar provisions that apply if you were self-employed at the time of the accident.
After 104 weeks, to qualify for income replacement benefits you must suffer from a complete inability to engage in any employment or self-employment for which you are reasonably suited by education, training or experience.
If you do not qualify as an employee for the purposes of income replacement benefits you may qualify for the non-earner benefit. You may qualify if you do not qualify for income replacement benefits, you were enrolled in school on a full time basis at the time of the collision or you completed your education less than one year before the collision and were neither employed or self employed as it related to our education, after completing your education and before you were in the collision. In addition, you must also suffer a complete inability to carry on a normal life as a result of the accident.
The amount of the non-earner benefit is $185 per week for the first 104 weeks, although no benefit is payable for the first 26 weeks following the accident. If you were enrolled in school or completed your education less than a year before the collision, this amount increases to $320 per week after the first 104 weeks.
Attendant Care Benefits
If as a result of the accident you require someone to care for you, this benefit is intended to cover those costs. To be entitled to this benefit an occupational therapist or a physician must complete a special form provided by the insurance company. Based on their assessment you may be entitled to up to $3000 per month for the first two years post accident with a cap of $36,000. If your injury is deemed to be catastrophic you can receive up to $1,000,000 for attendant care benefits.
You may be entitled to caregiver benefits if your injury is considered catastrophic and you were living with and were the primary caregiver for a person in need of care. There is a limit of $250 per week for the first person in need of care and $50 for each additional person in need of care. Again, these benefits are only available if you have sustained a catastrophic impairment or if you have purchased optional benefits.
Funeral and Death Benefits
If an insured has died as a result of a motor vehicle accident, the insurance company may be required to pay up to $6000 for funeral expenses.
Family members who were dependants may be entitled to specific payments under the SABS as follows:
- $25,000 to the victim’s spouse;
- $10,000 to each former supported spouse;
- $10,000 to each of the victim’s dependants or more if the victim had no spouse;
- $10,000 to the person upon whom the victim was dependant.
If at the time of the accident you are enrolled in school and as a result of your injuries you are unable to continue the program you may be entitled to lost educational expenses. These benefits are intended to compensate you for tuition, books, equipment, and room and board, whether incurred by you or on your behalf. This benefit is capped at $15,000.
Expense of Visitors
Spouses, children, grandchildren, parents, grandparents, brothers and sisters of the injured person may claim reasonable expenses for visitors. Out-of-pocket expenses such as mileage, meals, parking, hotel accommodation, airfare, child care costs and other similar type of expenses may be covered. In order to claim these expenses, receipts must be attached to the prescribed forms and submitted to the insurer.