- Cars Accidents
Ontario’s Accident Benefits are governed by the Statutory Accident Benefits Schedule (the “SABS”). Accident Benefits allow for a person insured under the Insurance Act of Ontario to obtain benefits after a motor vehicle accident regardless of who was at fault.
How do I apply for accident benefits?
Following a motor vehicle accident, you will need to contact your insurance company in order to fill out the necessary forms to obtain benefits. It is important to note that your insurer will not always automatically forward these documents to you.
You must first complete and submit an “OCF-1– Application for Accident Benefits Form” to your own insurer. Next, you will need to visit a health care provider in order to complete the “OCF-3– Disability Certificate” and the “OCF-18– Treatment and Assessment Plan”. These forms must indicate that you were in an accident and that you meet the relevant disability test as set out in the SABS. If you are eligible for and choose to apply for income replacement benefits, an “OCF-2– Employer’s Confirmation of Income Form” must be submitted to your insurer once completed by your employer. Other forms that may be relevant to you include the “OCF-10– Election of Income Replacement, Non-earner or Caregiver Benefit”, “OCF-23– Treatment Confirmation Form”, the “OCF-19– Application for Determination of Catastrophic Impairment” and the “OCF-6– Application for Expenses Form”.
What benefits can I get from SABS?
Medical and rehabilitation costs
The medical and rehabilitation benefit will cover reasonable expenses that are not covered by your government or private health plan. These expenses range from ambulance care to physiotherapy treatment. There are various limits that apply to this benefit depending on the severity of your injuries.
An insurer can deny paying medical and rehabilitation benefits if they believe the expenses you have incurred are not reasonably associated with the injuries from which you are suffering. The SABS defines what they consider to be a “cost incurred” in a three-part test that you must fulfill to obtain the benefit. First, you must receive the goods or services to which the expense relates. Next, you must have paid the expense, promised to pay the expense or are otherwise legally obligated to pay the expense. These first two components of the test are generally fulfilled without issue. The last component requires the person providing the goods or services to you to do so during his or her regular occupation or profession or to sustain an economic loss as a result of providing their goods or services.
The last component of the test prescribed in the SABS to determine whether you are eligible to obtain medical and rehabilitation benefits can create issues. In Josey v. Primmum Insurance Co., 2014 CarswellOnt 16385, the arbitrator held that the claimant’s spouse could not receive benefits for attendant care as she was not providing care in the course of her profession nor suffering an economic loss. The reasoning was the finding of legislative intent to exclude family members from being reimbursed for attendant care services in the absence of an economic loss. The SABS offers potential relief for the strict definition given to the word “incurred” by giving arbitrators and judges the discretion to decide what qualifies as a “cost incurred” under certain circumstances.
Housekeeping and home maintenance benefit
The housekeeping and home maintenance benefit is meant to assist you if you are unable to complete housekeeping tasks due to the injuries from which you are suffering. This benefit covers the cost of housekeeping services for up to $100 per week if you have suffered catastrophic injuries. It is an optional coverage for those suffering from minor or non-catastrophic injuries.
Weekly indemnity benefit
If you qualify for more than one weekly indemnity benefit, you must choose which benefit you wish to receive within 30 days of receiving the notice from your insurer. This decision is irreversible pursuant to subsection 35(1) of SABS.
There are three types of weekly indemnity benefits:
- Caregiver benefits
The caregiver benefit is meant to assist you if you are no longer able to continue as a primary caregiver by covering the costs of hiring someone to help you care for your family. Generally, it is offered to those who have dependents such as young children or aging parents. This benefit is paid at a rate of $250 per week plus $50 for each additional person in need of care. It is offered to those suffering from catastrophic injuries only, however, those suffering from minor or non-catastrophic injuries can obtain this coverage at an additional cost.
As per subsection 13(1) of the SABS, you must live with the person for whom you are caring in order to receive this benefit. However, the courts have previously ruled otherwise. In L (V) v. TD Meloche Monnex, the arbitrator decided that the issue of residence must be determined on a case-by-case basis to properly reflect different family arrangement and dynamics. In that case, the applicant who lived on his own 900 meters away from his parents was awarded caregiver benefits. (see s. 13 of SABS)
- Income replacement benefits
The income replacement benefit is calculated on a basis of 70% of your gross income to a maximum of $400 per week. In order to qualify for this benefit, you must be able to establish a substantial inability to perform your employment tasks. To continue receiving the benefit after the two-year post-accident mark, you must be completely unable to engage in any suitable employment based on your education, training or experience. (see s. 4-11 of SABS)
- Non-earner benefits
In order to qualify for non-earner benefits, you must suffer a “complete inability to carry on a normal life”. The SABS indicates that this two-year benefit is available at a rate of $185 per week, minus any other income replacement assistance, and only begins four weeks after the onset of the complete inability to carry on a normal life. (see s. 12 of SABS)
Which benefits am I entitled to under SABS regardless of my type of injury?
The injuries you have sustained in an accident will be designated under one of three categories in the SABS: a minor injury, a non-catastrophic injury, or a catastrophic impairment injury. The benefits available to you under the SABS depend on the designation of your injuries. That said, however, the following general benefits are offered independently of the designation of your injuries:
- Income replacement benefits (sections 6 and 7) – Available as a weekly benefit in cases where you are unable to return to work or self-employment—paid at 70% of gross income to the maximum of $400 per week. The benefit is not payable until the second week post-accident and terminates at 104 weeks unless you are completely unable to engage in any suitable employment based on education, training or experience;
- Non-earner benefits (section 12) – Available as a weekly benefit of $185 where you have suffered a complete inability to carry on a normal life;
- Benefits for damage to clothing and medical devices (section 24) – Available to reimburse items damaged in the accident. There is no monetary limit to this benefit;
- Lost educational expenses (section 21) – If you were enrolled in school at the time of the accident and unable to continue with your program, you may be eligible to obtain up to $15,000;
- Visitor’s expenses (section 22) – Available to reimburse immediate family members for their travelling expenses visiting you;
- Transportation expenses (sections 15 & 16) – Available to reimburse certain costs relating to travel for medical examinations or treatments;
- Death benefits (section 26) – In cases of fatality, a benefit of $25,000 is available to the spouse, $10,000 to a supported former spouse and $10,000 per dependant;
- Funeral benefits (section 27) – In cases of fatality, a basic benefit of $6,000 is offered.
Can I get WCB and weekly indemnity under SABS?
An insurer is not required to pay you benefits if, as a result of an accident, you are entitled to receive benefits under the Workplace Safety and Insurance Act, 1997 S.O., c 16, or any other workers’ compensation law or plan.
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Ontario's Accident Benefits are governed by the Statutory Accident Benefits Schedule (the “SABS”). Accident Benefits allow for a person insured under the Insurance Act of Ontario to obtain benefits after a motor vehicle accident regardless of who was at fault.What is SABS coverage in Ontario? ›
SABS coverage comes with every standard policy for auto insurance throughout Ontario. SABS coverage provides benefits to anyone hurt in a car accident. SABS coverage applies regardless of whether or not you are at fault for a collision. All auto insurance policies in Ontario offer basic SABS benefits.What are the statutory accident benefits in Ontario? ›
What Are Statutory Accident Benefits? Statutory Accident Benefits pay for expenses related to car accident injuries. This feature of Ontario car insurance pays for health costs not covered by OHIP or the government to help you recover from injuries and assistance with income related expenses.Is accident benefits coverage mandatory in Ontario? ›
In Ontario, residents who own and drive a car are required to purchase car insurance which must include: Liability coverage, Direct Compensation, Uninsured Automobile coverage and Accident Benefits coverage.What is minor injury guideline in Ontario? ›
The Minor Injury Guideline (MIG) is part of the Statutory Accident Benefits Schedule (SABS) and is in place to guide how accident victims are covered for goods and services by their insurers if their injuries fall within the definitions in the MIG.What are the 4 mandatory coverages in Ontario? ›
- Third-party liability coverage: ...
- Statutory accident benefits coverage: ...
- Direct compensation – Property damage (DC-PD) coverage: ...
- Uninsured automobile coverage:
The South African Bureau of Standards (SABS) is a specialized South African statutory agency responsible for the promotion and maintenance of standardization and quality relating to commodities and the rendering of services. It is a specialized agency of the Department of Trade and Industry.Whose insurance pays in an accident Ontario? ›
Ontario has a no-fault insurance system. This does not mean that you are never at fault for a car accident, but that your own insurance company pays your claims whether you're at fault.How long are accident benefits paid in Ontario? ›
Payable for 104 weeks after the accident if the insured person suffers a substantial inability to perform the essential tasks of his/her employment. Payable for up to 2 years from the date of the accident if the insured person suffers a substantial inability to perform the essential tasks of his/her employment.Who pays for an accident in Ontario? ›
Under Ontario's no-fault accident benefit system, your own car insurance company pays for the damage to your vehicle, no matter whose fault the accident was.
The minimum requirement for mandatory auto insurance in Ontario is $200,000 in Third Party Liability, Direct Compensation – Property Damage, Accident Benefits, and Uninsured Automobile coverage. Additional coverage can be purchased from an insurance representative.What happens if you get into an accident without insurance in Ontario? ›
If you are the uninsured driver with involvement in an accident, you will be held personally responsible. This will include responsibility for all the repairs to your vehicle, as well as any medical bills. You will also be financially responsible to pay for the damages to any other vehicle(s) in the accident.Can insurance companies refuse to insure you in Ontario? ›
In Ontario, it's overseen by the Financial Services Regulatory Authority (FSRA). So, while one insurance company might be allowed to deny you coverage, the entire auto insurance industry cannot deny you insurance coverage.What is the statute of limitations for personal injury in Ontario? ›
Ontario's Limitations Act sets a standard deadline for filing personal injury claims. This Act establishes a statute of limitations, called the basic limitation period, of two years which means claimants must commence their action within two years from the date of loss.What is personal injury law Ontario? ›
Personal injury law in Ontario cases of negligence result from a personal, business, corporation or government body failing to met their civic duty of exercising reasonable care to ensure their intentional actions do not put others in danger.What is considered a recordable injury in Ontario? ›
If a person is injured and unable to do their usual work or requires medical attention. As the employer, you must submit a written notification if a person is injured and unable to do their usual work or requires medical attention because of an accident, explosion, fire or incident of workplace violence.What is the process of SABS? ›
SABS Certification Process
A factory inspection will be conducted, during which product samples will be withdrawn for testing in an accredited laboratory. Test report will be analyzed, and if it indicates that a product meets the determined standards, SABS certification will be issued.
Not eligible for WSIB coverage
The WSIB does not extend coverage, under any circumstances, to the following individuals: Foreign diplomats. Competitors in individual or team sports. Stunt performers.
What is No Fault Insurance? Ontario has a "no-fault" car insurance system, but this does not mean that no one is at fault in an accident. The term "no-fault" insurance simply means if you are injured or your car is damaged in an accident, then you deal with your own insurance company, regardless of who is at fault.What are standard employee benefits in Ontario? ›
Mandatory employee benefits in Canada include pension, legislated and parental leaves, PTO, employment insurance, and eye exams. Common supplementary employee benefits include retirement, healthcare, voluntary and flexible benefits, healthcare spending accounts, gyms, and workplace canteens.