Ontario Accident Benefits and SABS Coverage Guide (2025–2026 Updates)

Navigating the world of auto insurance in Ontario can feel like a complex journey, especially when considering the critical protections offered by accident benefits. You’re not alone in seeking clarity! With unique provincial regulations and significant upcoming changes, understanding your coverage is more crucial than ever for maintaining financial security after a motor vehicle accident.

This comprehensive guide is designed specifically for Ontario drivers, providing expert-level knowledge to empower you. We’ll delve into the vital Statutory Accident Benefits Schedule (SABS), explore its mandatory and optional components, explain the application procedures, and, most importantly, provide a deep dive into the revolutionary regulatory changes taking effect in July 2026 that will reshape your coverage landscape. Whether you’re a new driver, an experienced professional, or someone seeking to maximize their protection, this resource will serve as your definitive reference.

Ontario Accident Benefits Explained: How Ontario’s No-Fault Auto Insurance Protects You

Ontario operates under a hybrid “no-fault” insurance system – a term that often causes confusion. What it means is this: regardless of who caused the accident, if you’re injured in a car accident, you primarily claim initial benefits from your own insurance company. This system, governed by the Statutory Accident Benefits Schedule (SABS) under Ontario Regulation 34/10 of the Insurance Act, is designed to ensure injured parties receive prompt access to medical care and financial support without needing to prove fault in court for these immediate benefits.

How is Ontario’s Auto Insurance System Different from Other Provinces?

Unlike traditional tort-based systems where you might solely rely on proving another driver’s negligence to receive any compensation, Ontario’s approach prioritizes immediate care and essential support directly from your own insurer. This is because accident victims need medical treatment and income assistance immediately, not after lengthy legal battles to determine fault.

The accident benefits are a mandatory part of every Ontario auto insurance policy, specifically outlined in Section 4 of the Ontario Automobile Policy (OAP 1). These benefits function independently from the liability coverage that protects you if you cause damage or injury to others.

Full List of Ontario Statutory Accident Benefits (SABS): Coverage Types and Limits

Ontario’s SABS offers a range of vital benefits to support your recovery and financial stability after an accident.

Income Replacement Benefit (IRB) under Ontario SABS: Eligibility and Amounts

The Income Replacement Benefit is a cornerstone of SABS, designed to replace lost wages when accident-related injuries prevent you from working.

Standard Coverage Details

• Provides 70% of your gross weekly income.
• Maximum benefit of $400 per week under standard coverage.
• Duration: Generally up to 104 weeks (approximately 2 years) for non-catastrophic injuries, but can extend longer for catastrophic injuries or if you are unable to return to any occupation.
• Tax-free benefit under the Canadian Income Tax Act.

Eligibility Requirements

• To qualify for IRB, you must meet specific criteria demonstrating your pre-accident employment status and current inability to perform your job due to accident-related injuries.
• The assessment considers your pre-accident income level and the extent to which your injuries genuinely impact your ability to work.
• For the first 104 weeks (2 years): You must demonstrate a “substantial inability to perform the essential tasks of your employment.”
• After 104 weeks: The test becomes a stricter “complete inability to engage in any employment for which you are reasonably suited by education, training, or experience.”
• Generally, you must have been employed or self-employed at the time of the accident, or have worked for at least 26 weeks in the 52 weeks prior to the accident.
• For those under 16, eligibility may apply if they were excused from attending school under the Education Act at the time of the accident.

Optional Enhancement Opportunities

• You can purchase optional coverage to increase your weekly benefit limits beyond the standard $400.
• Common optional limits include $600, $800, or $1,000 per week.
• This provides crucial income protection for higher earners whose standard $400 weekly maximum would be insufficient to maintain their standard of living during recovery.It is particularly valuable if 70% of your gross weekly income exceeds $400.

Medical, Rehabilitation, and Attendant Care Benefits in Ontario Auto Insurance

These benefits are crucial for your physical and mental recovery, covering treatments and services necessary after an accident.

Standard Medical & Rehabilitation Coverage

• For non-catastrophic injuries: up to $65,000 for medical, rehabilitation, and attendant care expenses combined, over a maximum period of 5 years (for adults). This includes the Minor Injury Guideline. ( minors may have an extended eligibility period.)
• For catastrophic injuries: up to $1,000,000 for medical, rehabilitation, and attendant care expenses combined, with no time limit.
• Covers reasonable and necessary treatments not covered by provincial health plans (like OHIP) or other extended health benefits (like employer plans).

Enhanced Optional Coverage

• For non-catastrophic injuries: increase to $130,000.
• For catastrophic injuries: increase to $2,000,000.
• These enhancements provide significantly greater resources for extended rehabilitation, specialized treatments, necessary equipment, and ongoing care.

The medical benefits cover a wide range of treatments including physiotherapy, massage therapy, occupational therapy, psychological counseling, prescription medications, medical equipment, and home modifications necessary for recovery and daily functioning.

Caregiver Benefit: Who Qualifies and How Much is Covered in Ontario?

This benefit recognizes the significant impact when an injured person can no longer provide care for dependent family members who require assistance with daily activities.

Coverage Parameters

• Available for those who provided care before the accident.
• Compensates for reasonable and necessary expenses incurred to replace your caregiving services.
• Standard coverage is limited to catastrophic injuries.

Optional Enhancement Opportunities

• Optional Enhancement Opportunities
• This provides broader support for families impacted by an accident by covering caregiver expenses for non-catastrophic injuries as well.
• You can purchase optional coverage to extend this benefit to all injury types, not just catastrophic.

Non-Earner Benefit in Ontario Accident Benefits: Eligibility and Payments

Designed for individuals who don’t qualify for income replacement (because they were not employed) but suffer a complete inability to carry on normal life activities due to accident injuries.

Who Qualifies

• Students, homemakers, retired individuals.
• Those not eligible for IRB or caregiver benefits.
• Must demonstrate complete inability to engage in normal pre-accident activities.
• Benefit amount: $185 per week for up to 104 weeks, with a 4-week waiting period.

Attendant Care Benefit: Coverage Details for Ontario SABS

This benefit covers the cost of personal care services when injuries require assistance with activities of daily living such as bathing, dressing, meal preparation, and mobility.

Coverage Scope

• Covers expenses for professional attendant care services.
• Includes transportation costs for attendants accompanying you to medical appointments.
• Benefit amounts are determined based on an assessment of your needs.
• Available for both catastrophic and non-catastrophic injuries, with differing coverage limits as part of the combined medical, rehabilitation, and attendant care limits.

Death and Funeral Benefits: Ontario Auto Insurance Payouts Explained

When a motor vehicle accident results in death, these benefits provide immediate financial support to eligible surviving family members.

Standard Death Benefits

• Lump sum to eligible spouse: $25,000.
• Lump sum per dependent: $10,000.
• Funeral expenses: up to $6,000.

Optional Enhanced Death Benefits

• Increased spouse benefit: $50,000.
• Increased dependent benefit: $20,000 per dependent.
• Enhanced funeral expense coverage: $8,000.

Housekeeping and Home Maintenance Benefits under Ontario SABS

These benefits help cover the reasonable and necessary costs of services you can no longer perform due to your injuries, such as cleaning, cooking, or yard work.

Standard Coverage

• Available only for catastrophic injuries.
• Covers essential household tasks and property maintenance.
• Benefit amount determined based on assessment.

Optional Coverage

• You can purchase optional coverage to extend these benefits to all injury types, not just catastrophic.
• This provides broader access to household service support for those with non-catastrophic injuries.

Ontario Accident Benefits 2026 Changes: What’s Mandatory and What’s Optional?

The landscape of Ontario’s auto insurance is undergoing a fundamental transformation. Effective July 1, 2026, most benefits previously considered mandatory under the Statutory Accident Benefits Schedule (SABS) will become optional to purchase. This represents the most significant shift in decades, placing greater responsibility on consumers to actively choose their level of protection.

What Remains Mandatory After July 1, 2026

• Basic Medical and Rehabilitation Benefits.
• Basic Attendant Care Benefits.
• These will still provide foundational coverage for treatment of accident-related injuries, up to the standard limits ($65,000 for non-catastrophic; $1,000,000 for catastrophic).

What Becomes Optional After July 1, 2026

• Income Replacement Benefits.
• Death and Funeral Benefits.
• Caregiver Benefits.
• Non-Earner Benefits.
• Housekeeping and Home Maintenance Benefits.
• Lost Educational Expenses.
• Expenses of Visitors.
• Damage to Clothing, Eyeglasses, Hearing Aids, etc. (under SABS).

Strategic Implications for Consumers

This monumental shift places unprecedented responsibility on consumers to make informed decisions about their coverage needs. Without careful planning and proactive selection of optional benefits, many Ontario drivers may find themselves severely underprotected in the event of a serious accident, facing significant out-of-pocket expenses or no coverage at all for benefits that were once standard. This could also lead to an increase in tort claims for losses no longer covered by SABS. It is crucial to speak to a licensed Agent or Broker to help you make an informed decision.

Who is Eligible for Statutory Accident Benefits in Ontario? Coverage Explained

Understanding who can claim benefits is crucial, as the SABS applies broadly.

Primary Coverage Categories

• Named Insureds and Family Members: The policyholder, their spouse, and dependent children living in the household are covered. This applies regardless of which vehicle they occupy during an accident (e.g., if they are a passenger in another car).
• Passengers and Pedestrians: Anyone injured while occupying your insured vehicle, or pedestrians struck by your insured vehicle, can claim benefits from your policy. This also extends to individuals not covered under any other auto insurance policy.

Priority of Coverage Rules

• Insurance on the vehicle you were occupying at the time of the accident.
• Insurance on the vehicle that struck you (if you were a pedestrian or cyclist).
• Your own auto insurance policy (if you were not in a car, or were in an uninsured car).
• The Motor Vehicle Accident Claims Fund (a last resort for uninsured or hit-and-run situations).

How to Apply for Ontario Accident Benefits: Step-by-Step Claims Guide

Prompt and accurate action after an accident is vital to securing your accident benefits.

Critical Timing Requirements

• Initial Notification: You must notify your insurance company within seven days of the accident, or as soon as reasonably possible thereafter. This notification initiates the claims process and helps ensure you don’t forfeit your right to benefits due to undue delay.
• OCF-1 Application Form: After notification, your insurer will provide the Ontario Claims Form 1 (OCF-1), which serves as your formal application for accident benefits. This comprehensive form requires detailed information about the accident, your injuries, employment status, and benefit requests.
• 30-Day Completion Deadline: The OCF-1 should ideally be completed and returned within 30 days of receiving it from your insurer. While late submission doesn’t automatically eliminate your right to benefits, it can result in delayed payments and processing.

Documentation and Assessment Requirements

• Medical Documentation: Your healthcare providers must complete specific forms documenting your injuries, treatment needs, and functional limitations (e.g., OCF-3 Disability Certificate, OCF-18 Treatment and Assessment Plan). These medical reports form the foundation of your benefit entitlements.
• Independent Medical Examinations (IMEs): Your insurer may require you to attend assessments by healthcare professionals of their choosing to verify your injuries and determine appropriate benefit levels. These examinations are typically conducted by independent companies to avoid conflicts of interest.

Ongoing Compliance Obligations

Throughout your claim, you may be required to provide additional documentation, attend examinations under oath, provide statutory declarations, or submit to further medical assessments. Failure to comply with reasonable requests can result in suspended or denied benefits.

Optional Accident Benefits in Ontario: Which Add-Ons Should You Choose?

Understanding and strategically selecting optional benefits can dramatically improve your financial protection and recovery outcomes after an accident, especially in light of the 2026 changes.

Income Replacement Enhancement Strategies

• Calculating Your Needs: Before selecting higher IRB limits, calculate 70% of your current gross weekly income. If this amount approaches or exceeds $400 per week, consider purchasing higher limits to maintain your standard of living during recovery.
• Professional and High-Income Earners: Professionals, business owners, and skilled trades workers often benefit significantly from purchasing $1,000 per week IRB coverage, as their income levels make the standard $400 weekly maximum inadequate for maintaining financial stability.

Medical and Attendant Care Coverage Optimization

• Enhanced Medical & Attendant Care Benefits: The upgrade from $65,000 to $130,000 for non-catastrophic injuries, or from $1,000,000 to $2,000,000 for catastrophic injuries, provides crucial additional resources for extended rehabilitation, specialized treatments, and adaptive equipment that may be necessary for a full and comprehensive recovery.

Specialized Optional Benefits

• Dependent Care Benefit: This optional benefit provides funds for additional childcare expenses if you were employed at the time of the accident and unable to care for your dependents due to your injuries. While standard SABS has limited provisions, specific optional forms (OPCFs) may offer limits like $75 per week for the first dependent and $25 for each additional dependent, up to a maximum of $150 per week.
• Indexation Benefit: This benefit adjusts your benefit payments annually for inflation, ensuring your purchasing power doesn’t erode during extended recovery periods.

Ontario SABS Injury Classifications: Minor, Non-Catastrophic, and Catastrophic

Ontario’s accident benefit system categorizes injuries into distinct classifications, each with different benefit entitlements and criteria.

Minor Injury Guideline (MIG)

• Definition and Scope: Minor injuries typically include soft tissue injuries (sprains, strains, whiplash-associated disorders), minor fractures, contusions, abrasions, lacerations, subluxations, and any clinically associated sequelae to such an injury. These are generally expected to resolve within a relatively short timeframe with appropriate treatment.
• Benefit Limits: For injuries falling under the Minor Injury Guideline (MIG), access to medical, rehabilitation, and attendant care benefits is limited to $3,500. This limit is for the benefits themselves, not a general “settlement amount” for the claim.
• Exiting the MIG: If your injuries are more complex, or if a pre-existing condition significantly complicates your recovery, it may be possible to argue that your injuries fall outside the MIG. This can open access to higher benefit limits.

Non-Catastrophic Injury Classification

• Comprehensive Coverage Category: This classification covers the majority of accident-related injuries that are more serious than minor injuries but don’t meet catastrophic thresholds.
• Benefit Limits: For non-catastrophic injuries, the maximum combined limit for medical, rehabilitation, and attendant care benefits is $65,000 over 5 years (unless optional coverage is purchased).

Catastrophic Injury Classification

• Severe Injury Recognition: Catastrophic injuries are the most severe, including specific types of brain injuries, spinal cord injuries, amputations, severe burns, and other conditions resulting in permanent, significant impairment. The criteria for catastrophic impairment are strictly defined in the SABS.
• Enhanced Benefit Limits: Individuals deemed catastrophically injured are entitled to a significantly higher combined limit of $1,000,000 for medical, rehabilitation, and attendant care benefits (unless optional coverage is purchased to increase it further). These benefits are available for life.

Common Accident Benefit Claim Issues & Expert Solutions in Ontario

Navigating an accident benefits claim can present challenges. Understanding your rights and available solutions is crucial.

Benefit Denial and Dispute Resolution

• Internal Appeals Process: Most benefit disputes begin with internal insurance company reviews. Providing comprehensive medical documentation and clear explanations of how your injuries relate to the accident strengthens your position.
• Alternative Dispute Resolution: Ontario provides mediation services through licensed mediators who specialize in accident benefit disputes, overseen by the Financial Services Regulatory Authority of Ontario (FSRA). This process can often resolve disagreements without the expense and time of formal legal proceedings.
• Legal Representation Considerations: For complex cases, significant injuries, or persistent benefit denials, seeking professional legal assistance from lawyers specializing in accident benefits and personal injury law is highly recommended.

Maximizing Recovery Outcomes

• Treatment Coordination: Successful recovery often requires coordinated care from multiple healthcare providers. Understanding how to navigate the approval process for various treatments ensures you receive necessary care without delays.
• Return-to-Work Planning: Income replacement benefits include provisions for gradual return-to-work programs that allow you to test your abilities while maintaining partial benefit support, encouraging a healthy and sustainable return to productivity.

How to Prepare for Ontario’s 2026 Accident Benefits Changes

The upcoming transformation of Ontario’s accident benefit system requires proactive planning to maintain adequate protection.

Assessment Framework for Coverage Decisions

• Income Protection Analysis: Calculate your total monthly expenses and determine how long you could maintain your lifestyle without income. This analysis helps determine if standard or enhanced IRB coverage levels (which become optional) are appropriate for your needs.
• Health Insurance Gap Analysis: Review your existing health insurance coverage (e.g., through your employer or privately) to identify gaps that accident benefits currently fill. Consider how purchasing optional medical and rehabilitation coverage under SABS might become even more important when other benefits become optional.
• Family Protection Considerations: Evaluate your family’s financial vulnerability in the event of your death or serious injury. Enhanced death benefits and caregiver coverage, both becoming optional, may become crucial purchases to protect your loved ones.

Professional Consultation Recommendations

• Review your current policy in light of the 2026 changes.
• Assess your individual needs and risk tolerance.
• Explain the implications of opting out of certain benefits.
• Help you develop a comprehensive coverage strategy tailored to your specific needs and circumstances under the new optional benefit structure.

Ontario Accident Benefits FAQ

Checklist: Reviewing Your Ontario Auto Insurance Before the 2026 SABS Changes

Understanding Ontario accident benefits is just the first step in protecting yourself and your family. The dramatic changes coming in July 2026 create both significant challenges and opportunities for savvy consumers who take proactive steps to secure appropriate coverage.

Now is the time to review your current auto insurance policy to understand your existing accident benefit coverage levels. Consider your income, existing health insurance coverage, family responsibilities, and overall financial obligations to determine whether purchasing additional optional coverage enhancements would provide valuable and necessary protection.

Most importantly, do not wait until July 2026 to make these critical decisions. Contact qualified insurance professionals now to discuss your options and develop a comprehensive strategy that ensures you maintain adequate protection under the new optional benefit structure. Your financial security and recovery outcomes after a motor vehicle accident depend on the coverage decisions you make today. Take the time to understand your options, assess your needs, and make informed choices that protect your future well-being and that of your loved ones.

Legal Disclaimer

This information is for educational purposes only and not professional advice. Insurance laws change, and individual needs vary. Every insurance company may offer different optional benefits and coverage limits, and the information herein is based on standard OAP1/SABS language. Always consult qualified professionals for personalized guidance. We are not liable for actions based on this content.

Peter Martire, (Chartered Insurance Professional), CRM, RIBO

Contact: peter.martire@begininsurance.ca

Last updated: August 2025 | Ontario insurance regulations and rates subject to change