Ontario Accident Benefits Lawyers
If you were injured in an automobile accident in Ontario, you can claim accident benefits even if you were at fault. These benefits are paid through Ontario’s automobile insurance system and can provide treatment, rehabilitation, attendant care and, where the applicable coverage exists, income support and other financial benefits.
Foster Injury Law represents injured people in accident benefits claims under Ontario’s Statutory Accident Benefits Schedule, commonly called the SABS. We handle serious injury claims involving denied treatment, income replacement benefit disputes, attendant care, catastrophic impairment applications and proceedings before the Licence Appeal Tribunal.
Accident benefits are not limited to drivers. Passengers, pedestrians, cyclists and motorcyclists injured in an accident involving an automobile can also have accident benefits rights.
How Our Ontario Accident Benefits Lawyers Help
An accident benefits claim often becomes difficult before the injured person expects a dispute. The insurer can refuse a treatment plan, restrict the claim to the Minor Injury Guideline, dispute whether the person can return to work, question the need for attendant care or deny a catastrophic impairment application.
Those decisions can affect recovery immediately. Someone with a serious injury should not be forced to delay necessary rehabilitation or manage a complicated insurance dispute while trying to recover.
Foster Injury Law represents clients in accident benefits claims involving brain injuries, spinal cord injuries, fractures and major orthopaedic injuries, serious psychological impairment, chronic pain, neurological symptoms and other injuries requiring extensive rehabilitation or care.
We assist with the insurance coverage that applies, the medical and functional evidence needed to support the claim, denied treatment and assessment plans, income replacement benefits, attendant care claims, catastrophic impairment applications, insurer examinations and disputes before the Licence Appeal Tribunal.
In a serious claim, forms are only the beginning. The evidence needs to show what the accident has changed, what treatment and care are required, how the injuries affect work and daily life, and why the benefits claimed are payable under the SABS.
Can You Claim Accident Benefits If You Were At Fault?
Yes. Accident benefits are available regardless of fault.
A driver who caused a collision can still claim available accident benefits for their own injuries. A passenger does not need to prove which driver was responsible before applying. A pedestrian, cyclist or motorcyclist injured in an accident involving an automobile will also have a claim.
Fault is relevant to a separate lawsuit against a negligent driver. It does not prevent an injured person from applying for benefits through Ontario’s no-fault accident benefits system.
What Accident Benefits Are Available in Ontario?
The benefits available in a claim depend on the injuries, the automobile insurance policy that applies and, once Ontario’s July 1, 2026 changes begin applying to policies, the optional coverage selected under that policy.
Medical and Rehabilitation Benefits
Medical and rehabilitation benefits pay for reasonable and necessary treatment and rehabilitation required because of accident-related injuries. Treatment can include physiotherapy, occupational therapy, psychological treatment, assessments, assistive devices, rehabilitation support and other services required during recovery.
Serious injury claims involve months or years of treatment. An insurer’s refusal to approve treatment can interrupt recovery when therapy, assessment or rehabilitation support is needed most.
Treatment plans are frequently denied because the insurer disputes the severity of the injuries, says the recommended treatment is not reasonable and necessary, relies on an insurer examination or takes the position that the person remains within the Minor Injury Guideline.
Attendant Care Benefits
Attendant care benefits address assistance required with personal care because of accident-related injuries. Depending on the injuries, a person can require help with bathing, dressing, mobility, safety, supervision or other daily needs.
These claims are especially important if injuries affect mobility, cognition, judgment, behaviour or independence. The fact that family members have stepped in to help does not mean that the need for care is not real.
Income Replacement Benefits
Income replacement benefits address lost income where accident-related injuries prevent a person from performing the essential tasks of their employment.
Where income replacement coverage applies, the benefit is generally calculated at 70% of gross weekly income, subject to the policy limit. Under the standard mandatory coverage currently in place, the maximum is generally $400 per week unless increased optional coverage was purchased.
Income replacement claims can become contested where someone is self-employed, has irregular income, attempted to return to work but could not continue, or has symptoms that do not appear clearly on a short insurer examination.
Other Benefits Under the SABS
Depending on the policy and the rules that apply to the claim, accident benefits can also involve non-earner benefits, caregiver benefits, housekeeping and home maintenance benefits, death and funeral benefits and certain accident-related expenses.
For accidents after Ontario’s July 1, 2026 changes begin applying to policies, it will be important to review the actual policy rather than assume that every person has the same benefits available.
How Much Treatment and Care Funding Is Available?
The amount available for medical, rehabilitation and attendant care depends heavily on how the injuries are classified under the SABS.
Minor Injury Guideline: Up to $3,500
The Minor Injury Guideline, usually called the MIG, generally limits medical and rehabilitation funding to $3,500.
The MIG is intended for certain minor injuries, including uncomplicated sprains, strains and whiplash-associated disorders. The problem is that the insurer’s initial classification can be made before the full effects of the injuries are understood.
Someone with continuing pain, concussion symptoms, neurological complaints, psychological injury or significant functional limitations should not assume the insurer is correct simply because their was placed in the MIG at the beginning.
Read more about What Is the Minor Injury Guideline in Ontario?
Non-Catastrophic Injuries Outside the MIG: Up to $65,000 Combined
Where the injuries fall outside the MIG but do not meet the legal test for catastrophic impairment, medical, rehabilitation and attendant care benefits are generally available up to $65,000 combined under the standard policy.
This category can apply to injuries that require substantial treatment and recovery support, even though they do not satisfy the strict definition of catastrophic impairment.
Catastrophic Impairment: Up to $1,000,000 Combined
If an injured person meets the SABS definition of catastrophic impairment, medical, rehabilitation and attendant care benefits are generally available up to $1,000,000 combined under the standard policy.
For a person with life-altering injuries, this difference can determine whether adequate rehabilitation, attendant care, occupational therapy, psychological treatment, equipment and long-term support are available.
What Is Catastrophic Impairment?
Catastrophic impairment is a legal designation under the SABS for injuries that meet one of the tests set out in the regulation. The fact that an accident was terrible or an injury is serious does not, by itself, determine the issue.
The tests include certain spinal cord injuries, serious brain injuries, amputations, blindness, severe psychological or behavioural impairment and qualifying whole person impairment assessments.
Some catastrophic impairment cases are obvious from the outset. Others depend on evidence developed over time. Someone with a brain injury or serious psychological impairment can appear physically independent while struggling with memory, judgment, concentration, emotional control, behaviour or the ability to manage ordinary daily activities.
Catastrophic impairment applications require evidence directed at the actual SABS criteria. Medical specialists, occupational therapists and rehabilitation professionals can be central to showing how the injuries affect the person’s functioning.
Read our detailed resource on Catastrophic Impairment in Ontario: Complete 2026 SABS CAT Guide.
Who Can Claim Accident Benefits in Ontario?
Accident benefits can be available where the injured person was driving, involved in a bus crash, travelling as a passenger, walking as a pedestrian, riding a bicycle, riding a motorcycle or otherwise injured through the use or operation of an automobile.
A person does not lose accident benefits rights simply because they do not own a car or do not have an automobile insurance policy in their own name. Ontario has priority rules that determine which insurer must respond to the claim. Where there is no available insurer, the Motor Vehicle Accident Claims Fund can become involved.
This is particularly important for pedestrians, cyclists and passengers. Someone who has been seriously injured should not assume there is no claim merely because they were not driving or do not know which insurer to contact.
What Forms Are Required for an Accident Benefits Claim?
Ontario accident benefits claims commonly involve several forms. The OCF-1 Application for Accident Benefits begins the claim. The OCF-3 Disability Certificate addresses the injuries and resulting disability. The OCF-18 Treatment and Assessment Plan is generally submitted by a treatment provider seeking approval for treatment or assessment. In a serious injury case, the OCF-19 Application for Determination of Catastrophic Impairment is used where catastrophic impairment status is being pursued.
These documents are important since the description of the injuries, the medical support filed with the insurer and the treatment being requested can shape the insurance company's initial position on the case. Incomplete or inaccurate information can create avoidable disputes about treatment, disability and entitlement to benefits.
What Is the Deadline to Apply for Accident Benefits?
An injured person should notify the insurer that they intend to claim accident benefits within seven days of the accident, or as soon as reasonably possible where that cannot be done within seven days.
After the insurance company provides the accident benefits application package, the completed OCF-1 Application for Accident Benefits should generally be returned within 30 days after receiving the forms.
A missed deadline does not automatically defeat every claim. There can be a reasonable explanation for delay. However, delay can interfere with access to treatment and financial support and provide the insurer with another issue to raise in a disputed file.
Why Are Accident Benefits Denied?
An insurer company might deny benefits needed for recovery. Treatment plans can be refused. The insurer can take the position that the injuries belong in the MIG, that ongoing symptoms are unrelated to the accident, that a person is able to work, that attendant care is not required or that the medical evidence does not meet a catastrophic impairment test.
Insurer examinations are another common source of dispute. The insurer can arrange an assessment and rely on the resulting opinion to deny treatment, discontinue income replacement benefits or refuse catastrophic impairment status.
The evidence required to challenge a denial depends on the benefit in dispute. A denied treatment plan requires evidence addressing the treatment and its connection to the injuries. An income replacement dispute might necessitate evidence about the person’s work, income and disability. A catastrophic impairment dispute needs evidence directed at the specific legal test being relied upon.
Read more about Denied Accident Benefits in Ontario.
How Are Accident Benefits Disputes Resolved?
Where an automobile insurer refuses to pay a benefit or disputes entitlement, the injured person can bring the dispute before the Licence Appeal Tribunal – Automobile Accident Benefits Service, commonly referred to as the LAT.
The LAT hears disputes about treatment and assessment plans, Minor Injury Guideline classification, income replacement benefits, attendant care, catastrophic impairment and other accident benefits issues.
Before a LAT application is started, the insurer’s reasons should be examined carefully. A significant accident benefits claim should be built around the precise decision being challenged and the medical, functional or financial evidence required to prove entitlement.
How Are Accident Benefits Changing in Ontario on July 1, 2026?
Ontario’s accident benefits structure changes for automobile insurance policies entered into or renewed on or after July 1, 2026.
Medical, rehabilitation and attendant care benefits remain mandatory. Other accident benefits, including income replacement, non-earner, caregiver, housekeeping, death and funeral benefits, become optional.
This means that two people injured in similar accidents can have different available benefits depending on the insurance policy that applies to them. Following the change, reviewing the relevant policy will become even more important when determining what benefits are available after an accident.
Read more about Ontario’s 2026 Accident Benefits Changes.
Are Accident Benefits the Same as a Car Accident Lawsuit?
No. An accident benefits claim and a lawsuit against an at-fault driver are separate claims.
Accident benefits are claimed through Ontario’s automobile insurance system and do not require proof that another person caused the accident. They address available benefits such as treatment, rehabilitation, attendant care and other losses covered under the policy.
A lawsuit is brought against the person whose negligence caused the injuries. It can include compensation for pain and suffering, income loss, future care costs and other damages caused by the collision.
Someone injured in a vehicle collision can have both claims at the same time: an accident benefits claim through the insurance system and a separate lawsuit against the at-fault driver.
While securing immediate, un-interrupted treatment funding through the Statutory Accident Benefits Schedule (SABS) is critical for early rehabilitation, it operates completely independently of a fault-based civil lawsuit. If another driver’s negligence caused your collision, your no-fault benefits represent only one layer of your financial recovery.
To recover comprehensive compensation for non-pecuniary general damages (pain and suffering), past lost income, and long-term loss of competitive advantage in the workforce, injured individuals must file a tort action against the at-fault driver. To see how your open insurance file directly intersects with a formal civil lawsuit—including navigating the statutory impairment threshold—review our comprehensive litigation framework for car accident claims in Ontario.
Speak With an Ontario Accident Benefits Lawyer
Serious accident benefits claims affect access to treatment, rehabilitation, attendant care and financial support at a critical point in recovery. When an insurer denies benefits, restricts a claim to the Minor Injury Guideline, disputes an inability to work or refuses catastrophic impairment status, the consequences can be significant.
Foster Injury Law represents injured people across Ontario in SABS claims and accident benefits disputes involving serious injuries. We can review the coverage that applies, the insurer’s decisions, the medical evidence and the steps required to pursue available benefits.
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