Statutory Accident Benefits In Ontario

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Injured In A Car Accident? You Are Entitled To Accident Benefits.

In Ontario, all victims of auto accidents are eligible to receive accident benefits.

However, determining the benefits you are eligible for and successfully filing a claim to your insurer can be confusing and overwhelming. That’s why De Rose Lawyers has a dedicated Accident Benefits team with 40 years of combined Statutory Accident Benefits experience.

What Are Statutory Accident Benefits?

If you are seriously injured in an auto accident, Statutory Accident Benefits help pay for medical and rehabilitative expenses, over and above OHIP and will provide some monies to augment any income that has been lost.

Therefore, Statutory Accident Benefits (SABS for short) are included with all basic automobile insurance policies issued in Ontario.

Additionally, accident benefits are paid through your own auto insurance provider, or the provider of the vehicle you were a passenger in. Therefore, if you were a pedestrian, and uninsured, you would receive accident benefits from the insurance company of the vehicle that struck you. If you are a pedestrian and struck by an automobile that is uninsured, you would claim benefits from the Motor Vehicle Accident Claims Fund administered by the province of Ontario.

Types of Statutory Accident Benefits

Income Replacement, Non-Earner and Caregiver Benefits

Income Replacement Benefits

  • If you can’t work as the result of an auto accident, you may be eligible for weekly income replacement benefits of 70% of your gross income up to $400/week.
  • Optional increases of up to $1000/week.

Caregiver Benefits

  • If you can no longer provide full-time care to a dependant (child or other) as a result of a catastrophic injury, you may be eligible for caregiver benefits to reimburse you for expenses to hire someone to take over for you.
  • Optional coverage is available to extend to all injuries.

Non-Earner Benefits

  • If your injuries prevent you from carrying on a normal life, and you don’t qualify for income replacement benefits or were a full-time student at the time of the accident, you may be eligible for non-earner benefits of $185/week.

Medical, Rehabilitation, and Attendant Care Benefits

Medical and Rehabilitation Benefits

  • Covers costs such as physiotherapy, prescriptions, chiropractic care, counselling, and transportation to medical appointments not covered by OHIP or your group insurance plan, but which are listed in the Statutory Accident Benefits Schedule.

Attendant Care Benefits

  • If you’ve been seriously injured in an auto accident, this helps cover costs should you require an attendant to care for you, either at home or in a healthcare facility.
  • The combined mandatory minimum coverage for Medical, Rehabilitation and Attendant Care Benefits is $65,000 for non-catastrophic injuries (fractures, sprains, etc.), and $1M for catastrophic injuries (loss of limb(s), quadriplegia/paraplegia, etc.).

Optional Coverage

  • You can increase benefits to $130,000 for non-catastrophic Injuries, or
  • Increase $1,000,000 for all injuries, for a total of $2,000,000 for Catastrophic Injuries, and
  • Increase combined all injury benefit to $1,000,000 and increase Catastrophic Injuries to $2,000,000

Death and Funeral Benefits

If you die as a result of an auto accident, benefits include payments of:

  • $25,000 to your spouse
  • $10,000 to each of your dependants
  • A maximum of $6,000 for funeral expenses

Optional Coverage

Benefits may be increased to:

  • $50,000 to your spouse
  • $20,000 to each of your dependants
  • $8,000 for funeral expenses

Other Expenses

Lost Educational Expenses

  • For those who can’t continue studies in an elementary, secondary, post-secondary or continuing education program as a result of injuries from an auto accident.
  • Covers expenses incurred before the accident, such as for tuition, books, equipment, and lodging, for a maximum benefit of $15,000.

Expenses of Visitors

  • Reasonable and necessary expenses incurred by some of those closest to you when they visit you during your treatment or recovery. This includes your spouse, children, grandchildren, parents, grandparents, siblings, certain other dependants and guardians, and those living with you at the time of the accident.
  • Expenses can be claimed for a maximum of 104 weeks after the accident, unless injuries are catastrophic.

Housekeeping and Home Maintenance Expenses

  • If you experience catastrophic injuries in an auto accident and need to hire someone to carry out your housekeeping or home maintenance responsibilities, you are eligible for up to $100/week.

Optional Coverage

  • Benefits may be extended to include all injuries.

How Do I Make A Statutory Accident Benefit Claim?

  • To file a claim, you must notify your insurance company immediately of the accident.
  • If you do not have an insurance company, you should notify the insurance company of the other vehicle(s) involved in the accident.
  • If you were self-employed at the time of the accident, you must be able to prove your income in order to receive benefits.
  • Additionally, certain accident benefits claims processes may require you to provide a sworn statement to a representative of the insurance company about the circumstances of the car accident and the injuries you suffered as a result.

Statutory Accident Benefits FAQs

Who Can Claim Accident Benefits?

Any person who was injured in a car accident. Additionally, certain relatives or dependants can also file for these benefits if they suffered psychological or mental injuries from the accident. Therefore, even if you weren’t directly involved in the accident, you may still be eligible for accident benefits. These benefits are to help you manage the psychological or mental trauma you’ve sustained due to an injured relative.

Do you have multiple insurance policies? In this case, there are special rules that dictate where you will receive benefits from.

How Do I Claim Accident Benefits?

Firstly, you have to report your car accident and any damages to your vehicle or property. After that, make sure to report your injuries to your insurance company. Claiming restitution for damages to property and claiming accident benefits are two separate reports.

How Long Do I Have to Claim Accident Benefits?

You should report your injuries to your insurance provider within 7 days of the incident. After that, your insurer will send you an Application for Benefits Form (also known as an OCF-1 Form). You will have 30 days to complete and return this form. However, if you miss the window, you aren’t necessarily out of luck, but you will need to provide a reasonable explanation for why you couldn’t complete it within the 30-day timeframe.

Next, your insurance company will ask for details about your injuries in order to assess your need for a certain benefit. It’s important you have a legal representative with you to assist you in the process.

After that, you’ll need your doctor or another medical professional to fill out a Disability Certificate (OCF-3 Form). This form lists the injuries and disabilities sustained and what tasks you can no longer do because of it. Additionally, this can include your ability to return to work.
Your insurer will then come back to you with a fixed amount to close your claim. Once you’ve accepted the amount, you cannot go back and request more. Therefore, it’s very important that you are satisfied with the amount offered. Additionally, you should always consult with a lawyer to make sure you are not entitled to more.

How much you settle for with your insurance can affect your personal injury claim if you decide to go after the at-fault driver. Do not sign anything from your insurer without talking to a lawyer if you’re considering taking legal action.

What If the Driver Doesn’t Have Insurance?

In the event that you were injured by an uninsured driver, you may be eligible for compensation from the Motor Vehicle Accident Claims Fund. In Ontario, it is illegal to drive a motor vehicle without having insurance. Unfortunately, that doesn’t stop all non-insured drivers from getting behind the wheel. The Motor Vehicle Accident Claims Fund was established to protect people injured in an accident where insurance isn’t available. You can learn more about the Motor Vehicle Accident Claims Fund here.

How Can A Personal Injury Lawyer Help Me File For SABS?

If you have been injured in a car accident, it’s crucial you are given access to the benefits that you’re entitled to. The benefits you receive from insurance can also affect how much money you receive in civil litigation. Therefore, you should always speak to a lawyer that specializes in personal injury. The personal injury lawyer will be able to help you make the right decision before signing any paperwork.

Our personal injury team at De Rose Lawyers will help you navigate the often overwhelming legal process. This way we can make sure you are fairly compensated. Our lawyers, with 40 years of combined experience, will guide you through the complex legal, medical, and insurance issues. This allows you to focus on what’s important – your rehabilitation and recovery.

Need Help With Your Accident Benefits Claims?

Navigating the legal process to obtain accident benefits can be confusing and overwhelming. Between recovering from your injuries, dealing with insurance companies, and struggling with medical expenses, we understand this is a stressful time. We are here to help.

We Fight For The Compensation, Care And Support You Deserve.

With 40 years of combined experience, De Rose Lawyers has a specialized Statutory Accident Benefits team. Our Accident Benefits Lawyers work to get our clients the maximum benefits they deserve, with minimal stress involved.

We will also provide helpful rehabilitation and recovery resources, allowing you and your loved ones to focus on the healing process.


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