Every auto insurance policy in Ontario includes mandatory coverage that is provided for in accordance with the Statutory Accident Benefits Schedule (SABS). This means that even if you cause an accident, you are still entitled to SABS. If you do not have a car insurance policy, you are entitled to claim these benefits from the insurer of the vehicle in which you were a passenger, the insurer of the vehicle that struck you if you were a pedestrian or cyclist, or even when dangerous road conditions were to blame. SABS operates under Ontario Regulation 34/10 of the Insurance Act and is meant to deliver medical support for accident victims
What is the purpose of SABS?
Depending on the nature of your injuries, the purpose of the SABS is to provide you with access to benefits, such as income replacement benefits, and medical, rehabilitation and attendant care benefits, as well as several other expenses.
- Income Replacement Benefits (IRBs): Weekly payment of income, calculated as a portion of your gross earnings, if you cannot work.
- Non-Earner Benefits (NEB): A weekly indemnity payment when you do not qualify for IRBs (students, unemployed and retired persons will often fall into this category), but your normal daily life has been disrupted.
- Caregiver Benefits: Provides a weekly payment when your injuries prevent you from caring for a dependent, but you do not qualify for an IRB or NEB (applies to catastrophic impairment injury only).
- Medical & Rehabilitation Benefits: Provides for treatments that OHIP does not cover, including physiotherapy, psychotherapy, chiropractic visits, and prescription medications.
- Attendant Care Benefits: Provides for professional services, such as those by a nurse or personal support worker, for personal care needs like getting dressed or bathing.
- Other Expenses: Provides for costs related to lost educational opportunities and visitor expenses.
Understanding Injury Categories and Benefit Limits
Your insurance company will place your injuries into one of three categories, and the classification determines how much funding you can receive for medical treatment, rehabilitation, and attendant care. Our lawyers regularly challenge these classifications when deemed to be incorrect.
- Minor Injury Guideline: Coverage capped at $3,500 for 5 years from date of accident.
- Non-Catastrophic Injury: Coverage limit of $65,000 for 5 years from date of accident.
- Catastrophic Impairment: Coverage extends up to $1,000,000 for lifetime.
It is to be noted that, depending upon the progression of your injuries and impairments, you may be moved from one category to another (i.e., you may be placed in the minor injury guideline, and later moved into the non-catastrophic injury category).
Important Regulatory Update:
Major changes to SABS become effective July 1, 2026. Medical and rehabilitation benefits will stay mandatory, but other coverages, including Income Replacement and Non-Earner Benefits, shift to optional status.
Reviewing your policy limits and coverage on a regular basis protects you and your family when accidents happen.
Overview of the essential forms to be completed
Upon notifying your insurer that you have been involved in a car accident, they will open an accident benefits file for you and forward a package of documents to be completed. It is important to note your claim number as well as the contact information, including phone and email, for the claims adjuster assigned to your file.
It is important that you notify your insurer that you were involved in an accident and have been injured right away. It is also important that you complete and submit the forms package provided to you as soon as possible. Consulting with a lawyer at Bogoroch & Associates LLP will ensure that the necessary forms are submitted to the insurer to facilitate the collection and management of your benefits without delay.
The most important and time-sensitive of these documents to be completed are listed and explained in the chart below:
|
Form Name |
Purpose |
Who Completes The Form |
|
|
OCF-1 |
Application for Accident Benefits. Completed by you as soon as practicable to provide the insurer with an overview of your background and injuries. |
You |
|
|
OCF-2 |
Employer’s Confirmation Form. Completed by your employer (or you if self-employed) if you were employed at the time of the accident and your injuries have affected your ability to work. |
Your Employer/You If You Are Self-Employed |
|
|
OCF-3 |
Disability Certificate. Completed by your doctor or treating medical practitioner to provide a summary of accident-related injuries, impairments, and pre-existing conditions. |
Your Doctor or Treating Medical Practitioner |
|
|
OCF-5 |
Permission to Disclose Health Information. Your lawyers will provide the insurer with copies of all reasonable and relevant documentation. |
|
|
|
OCF-6 |
Expenses Claim Form. To claim out-of-pocket expenses (such as medications, devices, or parking) that are not covered by extended health coverage. |
You or Your Lawyers |
|
|
OCF-10 |
Election of Benefits. Completed to elect the weekly indemnity benefit most suitable to your circumstances (income replacement, non-earner or caregiving). |
Your Lawyers |
|
|
OCF-18 |
Treatment and Assessment Plan. Submitted by your medical provider via HCAI to obtain treatment and allow for direct billing to the insurer. |
Your Doctor or Treating Medical Provider |
|
|
Form 1 |
Assessment of Attendant Care Benefits. Completed by a Registered Nurse or Occupational Therapist to assess needs if your injuries prevent you from independently carrying out your personal care. |
Registered Nurse or Occupational Therapist |
FAQs About SABS in Ontario
What Does SABS Cover in Ontario?
Statutory Accident Benefits (SABS) are mandatory "no-fault" benefits included in every standard Ontario auto insurance policy, designed to provide immediate support regardless of who caused the accident. The coverage available to you is largely determined by the severity of your injuries, which are classified into three distinct tiers. For Minor Injuries, such as sprains, strains, or whiplash, medical and rehabilitation coverage is capped at $3,500. For Non-Catastrophic Injuries, which include more severe conditions like broken bones or concussions that are not life-altering, the standard combined limit for medical, rehabilitation, and attendant care is $65,000 for up to five years. The highest tier is for Catastrophic Impairment (CAT), such as for traumatic brain injuries, paralysis, or loss of limbs, where the standard combined limit increases to $1,000,000 available over your lifetime.
Beyond medical care, SABS provides financial safety nets. If your injuries prevent you from working, Income Replacement Benefits pay 70% of your gross income up to a standard maximum of $400 per week. Those who were not employed at the time of the accident, such as students or retirees, may qualify for a Non-Earner Benefit of $185 per week, starting after a four-week waiting period. While benefits like Caregiver and Housekeeping expenses are generally available only for Catastrophic Injuries, they are generally not available for Non-Catastrophic claims unless you purchased optional upgrades on your policy. Finally, while fault is usually irrelevant, insurers can deny specific benefits if you were driving without valid insurance, without a licence, or were convicted of a criminal offense related to the accident.
How Long Do I Have to Apply for SABS?
Strict adherence to timelines is critical in insurance claims to avoid delays or denials. You are required to notify your insurance company that you intend to apply for benefits within 7 days of the accident occurring. Once the insurer provides you with the application package, you must complete and submit the OCF-1 (Application for Accident Benefits) within 30 days. If you miss this 30-day window, you are not automatically disqualified, but you must provide a reasonable explanation for the delay, such as hospitalization or an inability to function due to the severity of the injury. It is important to note that simply not knowing about the deadline is rarely accepted as a valid excuse.
Can I Receive SABS and Sue at the Same Time?
You absolutely can, as Ontario operates under a hybrid system that allows for both no-fault benefits and tort (lawsuit) claims simultaneously. While SABS is provided to cover immediate medical needs and some income replacement, a lawsuit is filed against the at-fault driver's insurance to recover damages that SABS does not fully cover. This includes compensation for pain and suffering, loss of enjoyment of life, and income losses that exceed the $400 weekly SABS cap.
However, the legal principle against "double recovery" prevents you from being paid twice for the same financial loss. Consequently, when you settle your lawsuit, the at-fault driver's insurer will deduct the total amount of money you have already received from SABS for income or medical care from your final settlement award, depending on the nature of the recovery.
Examinations Required by the Insurer
To determine your entitlement to benefits or your continuing entitlement to benefits, including but not limited to, income replacement benefits, attendant care benefits and/or medical and rehabilitation benefits, please note that your auto insurer will arrange for you to be assessed by medical examiners of their choosing, but not more often than is reasonably required. If needed, the insurer will provide interpretation services as well as transportation services.
For more details, visit our Accident Benefits Form page.
Contact Our Personal Injury Lawyers Today for More About SABS in Ontario
When you or someone you love gets injured, reach out to our personal injury lawyers at 1-866-599-1700 for a free consultation. We work with clients throughout Toronto, Brampton, Mississauga, and all of Ontario using a contingency fee structure, meaning you do not pay us anything unless we obtain compensation for you.
