What are statutory accident benefits?

At a glance: If you are seriously injured in an auto accident in Ontario, Statutory Accident Benefits pay for expenses not covered by healthcare to treat you, replace your income and more.

The Statutory Accident Benefits Schedule, or SABS for short, is a mandatory no-fault auto insurance coverage in Ontario, and is included with all basic auto insurance policies.

Administered by the Automobile Accident Benefits Service of Ontario, accident benefits are paid through the auto insurer covering your vehicle (or the vehicle in which you were a passenger). If you suffer injuries when hit by a vehicle as a pedestrian or bicyclist, you can apply for Statutory Accident Benefits either through the insurance company of the driver that hit you (if you don’t have your own policy) or through your own provider. As the injured pedestrian or cyclist, you need to notify the insurer you’re filing your claim through within seven days of the accident.

Note as well that if any injured person has benefits from their employer or another policy then that would be taken into consideration before Statutory Accident Benefits would kick in.

What’s covered by statutory accident benefits?

Statutory Accident Benefits, or SABS, include:

  1. Income Replacement, Non-Earner and Caregiver Benefits
  2. Medical, Rehabilitation, and Attendant Care Benefits
  3. Death and Funeral Benefits
  4. Other Expenses

See also: Complete Statutory Accident Benefits Schedule

1. Income replacement, non-earner and caregiver benefits

  • Income replacement benefits: If you can’t work as the result of an auto accident, you may be eligible for weekly income replacement benefits of 70% of your gross income up to $400/week.
    • You have the option to increase this benefit to $1,000/week for an additional premium.
  • Caregiver benefit: If you can no longer provide full-time care to a dependant (child or other) as a result of a catastrophic impairment, you may be eligible for caregiver benefits to reimburse you for expenses to hire someone to take over for you.
    • Optional coverage is available to extend this benefit to all injuries.
  • Non-earner benefits: If your injuries prevent you from carrying on a normal life, and you don’t qualify for income replacement benefits or were a full-time student at the time of the accident, you may be eligible for non-earner benefits of $185/week.

2. Medical, rehabilitation, and attendant care benefits

  • Medical and rehabilitation benefit: Covers costs such as physiotherapy, prescriptions, chiropractic care, counseling, and transportation to medical appointments not covered by OHIP or your group insurance plan, but which are listed in the Statutory Accident Benefits Schedule.
  • Attendant care benefit: This covers the cost of an attendant, should you require one to care for you, either at home or in a healthcare facility, if you’ve been seriously injured in an auto accident.

The combined mandatory minimum coverage for Medical, Rehabilitation and Attendant Care Benefits is $65,000 for non-catastrophic injuries, and $1 million for catastrophic injuries (loss of limb, quadra/paraplegia).

  • Optional coverage: For an additional premium, you can increase the limits as follows:
    1. You can increase benefits to $130,000 for non-catastrophic injuries
    2. You can increase benefits to $1 million for non-catastrophic injuries, and $2 million for catastrophic injuries
    3. If you’ve already increased to $1 million for non-catastrophic injuries, you can increase your coverage to $3 million for catastrophic injuries

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3. Death and funeral benefits

If you die as a result of an auto accident, benefits include payments of:

  • $25,000 to your spouse
  • $10,000 to each of your dependants
  • A maximum of $6,000 for funeral expenses

Optional coverage

Benefits may be increased to:

  • $50,000 to your spouse
  • $20,000 to each of your dependants
  • $8,000 for funeral expenses

4. Other expenses

  • Lost educational expenses: For those who can’t continue studies in an elementary, secondary, post-secondary or continuing education program as a result of injuries from an auto accident. It covers expenses incurred before the accident, such as for tuition, books, equipment and lodging, for a maximum benefit of $15,000.
  • Expenses of visitors: Reasonable and necessary expenses incurred by some of those closest to you when they visit you during your treatment or recovery. This includes your spouse, children, grandchildren, parents, grandparents, siblings, certain other dependants and guardians, and those living with you at the time of the accident. Expenses can be claimed for a maximum of 104 weeks after the accident, unless injuries are catastrophic.
  • Housekeeping and home maintenance expenses: If you experience catastrophic injuries in an auto accident and need to hire someone to carry out your housekeeping or home maintenance responsibilities. Up to $100/week. Optional coverage: Benefits may be extended to include all injuries.

Download the statutory accident benefits schedule

Read or download the complete Statutory Accident Benefits Schedule from the Government of Ontario website.

Frequently asked questions about SABS:

An EUO is an in-person interview of a person claiming Accident Benefits. It is conducted by the insurance company, with the goal of verifying the authenticity of the claim. Insurers have the discretion to conduct such an examination whenever an Accident Benefits claims is made, but typically it is used in instances where the insurance adjuster suspects fraud. The results of the examination can be used to deny the claim or limit benefits. If the claimant refuses to submit to the examination, the insurer can suspend benefits. The claimant is allowed to have their lawyer present.

In order to make sure that insurance benefits go where they are most needed, different policy limits have been created under the SABS for different classes of injury. Medical and rehabilitation benefits for a minor injury, for example, are limited to a maximum of $3,500. On the other hand, if a motor vehicle accident leads to a catastrophic impairment, the injured party is entitled to up to $1 million in rehab benefits.

The definition of a catastrophic impairment is quite complex, but essentially, to be considered catastrophic, injuries need to significantly impact the person’s ability to function, and the impairment must be permanent. Examples include blindness, paralysis and permanent brain damage.

See the full definition in section 3.1 of the SABS.

In cases where victims of a motor vehicle accident suffer minor injuries, the minor injury guideline allows expedited access to rehab services like chiropractic and physiotherapy to ease symptoms like pain and minor disability. It also caps benefits in these instances to prevent minor sprains and strains from costing the auto insurance system tens of thousands of dollars over several years of treatment.

Typically, sprains, strains, whiplash injuries and subluxations fall under the guideline, which promotes quick access to treatment and a quick resolution of the claim. Medical and rehabilitation benefits for minor injuries are limited to $3,500.

In Ontario, there are a number of official forms that must be filled out when an auto insurance claim is made. OCF stands for “Ontario Claims Form”. The OCF-19 would be completed if you wanted to apply to an insurance company to have your injuries deemed “catastrophic”. If you are successful in getting the catastrophic designation, you will have access to much higher limits in terms of medical and rehabilitation benefits. Benefits for a non-catastrophic injury are typically capped at $65,000, whereas a catastrophic designation gives you access to up to $1 million in benefits.

Have questions about your statutory accident benefits coverage?

Give our insurance experts a call to determine what amount of coverage is best for you and your family at 1-800- 731-2228 or request an auto insurance quote. We’d be happy to help you with any type of insurance.

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