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What Is the Statutory Accident Benefits Schedule in Ontario?

If you have valid automobile insurance and were injured in an automobile accident, you are entitled to Ontario’s standard auto insurance policy benefits.

This coverage applies for anyone injured in a car accident, regardless of who was at fault for the accident, and even if you were a cyclist or pedestrian hit by a motor vehicle, with no insurance of your own. The Statutory Accidents Benefits Schedule (SABs) is a regulation to the Ontario Insurance Act and provides injured parties benefits under Ontario’s “no-fault” insurance system.

Your Obligations as the Insured

It is best to review your Ontario Automobile Policy as it outlines your rights and responsibilities under the contract, in greater detail that can be provided here. Included in the policy, you will find that the accident must be reported to your insurer within seven days or as soon as possible after that. If you do not report an accident within a reasonable amount of time, you could be denied the claim by your insurer.

When contacting your insurer to report the claim, the following information should be provided, including: your name and licence number, the date, time and location of the accident, the extent of any injuries, the number of passengers involved, if any, the extent of damage to the vehicle, your description of the accident, the names and driver’s licence numbers of the other drivers, as well as the names of their insurance companies and their auto insurance policy numbers, the licence plate and vehicle identification numbers of the other vehicles; and the name and badge number of the investigating police officer & incident file number.

Once your automobile insurer has been notified that you sustained injuries from the accident, a package of OCF claim forms will be mailed to you. At minimum, Forms 1-5 will be sent: Form 1 “Application for Accident Benefits” (OCF-1), Form 2 “Employer’s Confirmation of Income” (OCF-2), Form 3 “Disability Certificate” (OCF-3), Form 4 “Permission to Disclose Health Information” OCF-5), and Form 5 “Treatment Confirmation Form” (OCF-23). These OCF forms must be completed in full, signed, and returned to the insurer within 30 days of receiving the application forms. If the insurer requests any further information (e.g., examination under oath), the information must be provided within 10 business days of receiving the request.

As the insured, you have a positive obligation to seek medical attention for your injuries incurred from the accident and to obtain recommended treatment immediately, in order to mitigate your damages. You also must attend follow up appointments advised by your doctor, who may decide on other treatment as you recover or if the initial treatment is not working.

Obligations of the Insurer to Pay Income Replacement Benefits

If you are unable to work as a result of the accident, your insurer may be obliged to pay the income replacement benefit, which is partial compensation for your lost time from work. Under the basic benefits, income replacement benefits are the lesser of $400 per week or 70% of net income, with eligible gross income calculated using a variety of documents, such T4s, pay stubs, income tax returns and bank statements.

The maximum period of coverage is up to 104 weeks (or two years) from the date of the accident and a one week waiting period applies before income replacement benefits begin.

Ineligible Coverages

If the accident did not occur while you were in the course of work, you will not have a Workplace Safety Insurance Board claim for income replacement. The appropriate body for income replacement would be your personal auto insurance provider as the cause of disability was a personal automobile accident.

Similarly, if you are eligible for income replacement benefits from your auto insurance provider, you will not additionally qualify for Employment Insurance Sickness Benefits, which provides an average of 55% of insured weekly earnings up to $547 per week (for a maximum of 15 weeks).

Obligations of the Insurer to Pay Medical and Rehabilitation Benefits

The insurer may be liable to pay medical and rehabilitation benefits if your doctor recommends such treatment and you obtain the treatment and submit receipts as proof, up to a maximum combined benefit of $65,000. The medical and rehabilitation benefit covers expenses that aren’t already covered by government or personal healthcare policies. Since physiotherapy is not covered by the Ontario Health Insurance Plan, for example, the auto insurer may provide coverage. However, a limit typically applies for each type of expense.

If your treatment provider considers you to suffer a “minor injury” (defined in the Schedule as being “one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury”), then the medical and rehabilitation benefits are subject to specific monetary cap (known as the “Minor Injury Guideline”) of $3500 for one accident (per s.18(1) of the SAB Regulations) unless there was a pre-existing condition that was exacerbated by the accident, that was documented prior to the accident, in which case the cap of $3500 may be waived.

Obligations of the Insurer to Pay Other Expenses

Your insurer may be responsible to pay for certain expenses, such as replacement for protective/medical devices. Section 24 of the SABs Regulation specifies damage to “clothing, glasses, hearing aids, other medical or dental devices”.

Additionally, you may be eligible to claim reasonable transportation expenses to medical appointments and reasonable expenses of visitors during your treatment or recovery (per s.22(1) of the SAB Regulations). For example, the cost of your spouse, children, parents or siblings to visit you in the hospital may be covered.

You may also be eligible for a property damage claim (e.g., for vehicle damage) under the auto insurance policy. Keep in mind there is no coverage for moveable items that are not permanently fixed to the vehicle (e.g., damage to a non-movable car stereo system would be covered, but not damage to an iPhone).

Coverage for a temporary rental vehicle may be available to you, depending on your specific automobile insurance policy coverage, and usually for seven days. During that time your vehicle would undergo repairs or you may be asked by the insurer to find a replacement vehicle. Your doctor would have to have no concern with your ability to drive.

There are other types of benefits that may or may not apply to you, including attendant care, caregiver benefits, housekeeping and home maintenance benefits. Your specific auto insurance policy will have more details.

Contact Tamming Law for Help From an Accident Benefit Lawyer in Collingwood

If you have concerns about completing the insurance forms properly and wish to avoid potential disputes with your auto insurance provider over the payment of benefits, contact us at Tamming Law for legal services in Owen Sound. We can help you to access the benefits you deserve. Call today at 1-888-945-5783.