Accident Benefits

The system is governed by the Statutory Accident Benefits Schedule (SABS), which sets out what benefits are available and how they are assessed. After an accident, you must apply through your insurer and provide medical documentation to support your claim. From there, the insurer will review treatment plans, income loss, and care needs to determine what accident benefits coverage applies.

While the framework is structured, the process itself is rarely straightforward. Many individuals encounter delays, denied treatment plans, or disputes over how injuries are classified. Understanding how the system works early on can make a significant difference in accessing the benefits you need.

In Ontario, accident benefits coverage is divided into categories based on injury severity:

• Minor injuries are generally limited to $3,500 for medical and rehabilitation
• Non-minor injuries provide up to $65,000 combined for medical, rehabilitation, and attendant care
• Catastrophic injuries provide up to $1,000,000 combined for these same benefits

These limits can have a direct impact on your access to treatment and long-term care. For example, individuals with injuries categorized as “minor” may find that funding is quickly exhausted, even if symptoms persist beyond initial treatment. On the other hand, access to higher limits for non-minor or catastrophic injuries often depends on strong medical evidence and proper documentation.

It is also important to understand that insurers may challenge how your injuries are classified, particularly when a claim may move beyond the Minor Injury Guideline or toward a catastrophic impairment designation. These disputes can affect your access to ongoing care, rehabilitation, and long-term support.

In some cases, optional benefits purchased under your policy may increase these limits, but many individuals are unaware of their coverage until after an accident occurs. Understanding how these limits apply (and how they may be disputed) is an important part of protecting your entitlement to accident benefits.

After a motor vehicle accident, you should notify your insurance company as soon as possible – ideally within 7 days. The insurer will then provide you with an accident benefits application package, which includes forms outlining your injuries, employment status, and treatment needs.

Timelines are critical. Once you receive the application package, you have 30 days to complete and return the forms. Missing this deadline can delay your claim or give the insurer grounds to deny benefits, although extensions may be granted with a reasonable explanation. It is also important to submit medical forms as early as possible, since insurers rely on this information to determine eligibility.

There are also strict deadlines for treatment plans and disputes. For example, insurers must respond to most treatment plans within a set timeframe, but delays often occur if additional information or insurer examinations are requested. If a benefit is denied, you typically have 2 years from the date of the denial to dispute the decision through the Licence Appeal Tribunal (LAT).

Because accident benefits insurance claims depend heavily on documentation, incomplete forms, inconsistent medical reporting, or missed deadlines can significantly affect your access to benefits. Ensuring that your application is accurate, supported by medical evidence, and submitted on time can help avoid unnecessary delays and challenges early in the process.