Accident benefits, also called no-fault benefits or SABS (Statutory Accident Benefits Schedule), are insurance benefits available to people injured in a motor vehicle accident in Ontario, regardless of who caused the crash. Drivers, passengers, pedestrians, and cyclists can all qualify depending on the circumstances and their connection to an auto insurance policy.

• Available regardless of fault, you do not need to prove the other driver was responsible
• Covers medical treatment, rehabilitation, income replacement, and attendant care depending on injury severity. For serious injuries such as traumatic brain injuries, spinal cord injuries, and significant fractures, higher benefit limits may be available under a catastrophic impairment designation
• You apply through your own auto insurer, not the at-fault driver’s insurer

If you were injured in a car accident, contact Hoffman Law or visit our motor vehicle accidents page to understand your full rights.

Notify your insurer as soon as possible after the accident and request the accident benefits application package. The process involves completing forms and submitting medical documentation that supports your injuries, treatment needs, and, where applicable, your inability to work.

• Request the SABS forms from your insurer and note all filing deadlines
• Have your doctor document your restrictions and how they affect your ability to work and function daily
• Submit the completed package promptly and keep copies of everything
• Track all symptoms, appointments, and expenses from the start, gaps in documentation are used against claimants

Accident benefits coverage is not one-size-fits-all, what you receive depends on the severity and documentation of your injuries, your policy limits, and which benefits you apply for and qualify under. Injuries such as traumatic brain injuries, spinal cord injuries, and serious fractures may qualify for significantly higher benefit limits if the impairment meets the threshold for a catastrophic designation under Ontario’s accident benefits framework. Mandatory benefit categories include:

• Medical and rehabilitation benefits: treatment and therapy costs supported by a treatment plan
• Attendant care benefit: for those who need personal assistance with daily living activities due to their injuries

Additional optional benefits are only available if you purchased these benefits at the time of renewing or purchasing your motor vehicle insurance:

• Income replacement benefits (IRBs): for employed claimants whose injuries prevent them from working.
• Non earner benefits (NEBs): for claimants not working at the time of the accident whose injuries substantially affect daily life.
• Caregiver benefits
• Housekeeping and home maintenance benefits
• Lost educational benefits
• Visitor expenses
• Damages to personal items benefits
• Death benefits
• Funeral benefits

Coverage at each level depends on medical evidence and assessments, strong, specific documentation from your treating practitioners is the foundation of every successful accident benefits claim.

The income replacement benefit (IRB) may be available if you purchased this optional benefit and if injuries prevent you from performing the essential tasks of your pre-accident employment. The benefit is calculated as a percentage of your pre-accident net income, subject to a weekly maximum that depends on your policy.

To qualify, you need medical evidence that clearly establishes your functional restrictions and ties them specifically to your inability to do your job. Disputes frequently arise where the insurer’s assessment says you can return to work but your treating practitioners say otherwise.

If your IRB claim has been denied or cut off, contact Hoffman Law to review your options.

The non-earner benefit may be available if you purchased this optional benefit, and you  were not employed at the time of the accident and your injuries cause a complete inability to carry on a normal life. This is a high bar, the insurer will look at how your daily activities, independence, and functioning have been affected, not just your diagnosis.

Detailed and consistent functional documentation from your treating practitioners is essential. Insurers frequently dispute this benefit by pointing to activities a claimant can still perform rather than what they cannot.

The attendant care benefit may be available if your injuries mean you require assistance with personal care and daily living activities, such as bathing, dressing, meal preparation, or mobility. The level of benefit depends on an assessment of the care you actually need and how much of it is being provided.

Eligibility and quantum are frequently disputed by insurers. If you believe you qualify but benefits have been denied or limited, the medical and functional evidence supporting the care assessment is the key to challenging that decision.

A denial or cutoff is not final. Insurers commonly deny treatment plans, reduce approved amounts, or terminate benefits by claiming treatment is not reasonable and necessary, often based on their own assessors, not your treating practitioners. This is especially common in claims involving brain injuries, spinal injuries, or serious fractures, where the cost of ongoing rehabilitation and attendant care is highest and insurers have the greatest financial incentive to limit benefits. Each denial should be reviewed against the specific medical and policy grounds the insurer relies on.

• Request the denial in writing and note any response or appeal deadlines
• Gather updated, specific medical evidence that addresses the insurer’s stated reasons
• Track the financial and health impact of every missed treatment or benefit payment
• Do not assume the insurer’s assessment is correct or final

The sooner you get legal advice after a denial, the more options you have. Contact Hoffman Law to review your denial.