Your guide to accident benefits in Ontario

What are accident benefits?

Accident benefits are a collection of coverages that are part of every car insurance policy in Ontario (and other provinces). While car insurance policies certainly cover damage to the vehicle itself, they also help with the financial burden that arises when someone is injured (or killed) in an accident.

Ontario’s Statutory Accident Benefits Schedule (SABS) describes the benefits available on every car insurance policy sold in the province. There are standard benefits that are always available, but there are also several options for expanding those benefits — more to come on that later.

One thing to note before we continue: Some accident benefits differentiate between catastrophic injuries and non-catastrophic injuries. What’s the difference? Generally speaking, a catastrophic injury is one that causes severe, permanent impairment to the injured person. That includes loss of limbs, paralysis, loss of vision, and similar severe injuries that permanently affect the injured person’s ability to carry on their normal life.

How do accident benefits work?

One major difference between accident benefits and many other insurance coverages is that accident benefits are available to everyone. That includes people who don’t have car insurance policies. Everyone involved in an accident can access accident benefits: drivers, passengers, pedestrians, and other bystanders.

If you’re involved in an accident, and you have car insurance, your own claims adjuster will help you apply for accident benefits. If you’re injured in a vehicle accident as a pedestrian, you can claim accident benefits from the insurer of the vehicle that injured you. Even if there is no insurance policy available whatsoever (like a pedestrian injured in a hit and run or by an uninsured motorist), it’s possible to claim accident benefits from the Motor Vehicle Accident Claims Fund.

Again, if you have your own car insurance, you’ll apply for accident benefits with your provider. For other situations, the Financial Services Regulatory Authority of Ontario (FSRAO) provides this list of scenarios:

Income replacement, caregiver benefits, and non-earner benefits

This collection of accident benefits helps injured people who can’t work because of their injuries, or who need to take time away from their job to care for an injured person.

Income replacement

Income replacement helps cover lost wages for people who need to take time away from work because of their injuries. The default benefit covers up to 70% of a person’s gross income, capped at $400 per week. There are options available to raise that cap to $600, $800, or $1000 per week.

Non-earner benefits

Non-earner benefits provide compensation to people who are injured in an accident, but under different circumstances than income replacement.

There are two possible conditions that someone might qualify for non-earner benefits. In either case, they must have suffered a complete inability to carry on a normal life because of the accident. In addition to that, they must meet either of the conditions below:

1. They do not qualify for income replacement.
2. They were enrolled in elementary, secondary, or post-secondary education full time, or they completed their education less than one year prior to the accident and weren’t employed (or self-employed) in a position that reflected their education.

In either case, non-earner benefits are only available for up to two years following the accident. The benefit will pay $185 per week to eligible people for the duration that they’re unable to carry on their normal life.

Non-earner benefits aren’t available for people under the age of 18, or people who choose to receive the income replacement benefit instead.

Caregiver benefit

The caregiver benefit will help cover the cost of hiring a caregiver if a primary caregiver is injured in an accident. The conditions to qualify for the caregiver benefit are:

1. The caregiver has to live with the person in need of care.
2. The caregiver is the primary caregiver for the person in need of care, and wasn’t paid for their caregiving activities.

For example, a caregiver may be a single parent, a stay-at-home parent, or someone taking care of a disabled family member or elderly parents.

The caregiver benefit is limited to $250 per week for one dependant, plus $50 per week for each additional dependant. With basic coverage, this benefit is only available for catastrophic injuries — those that permanently impair a person’s ability to carry on their life. There is an option to make it available for all injuries, however.

The caregiver benefit is available for up to two years following the accident.

Medical, rehabilitation, and attendant care benefits

This set of benefits helps cover additional costs associated with the actual process of recovering from an injury. While some medical and rehab costs are covered by public (or private) health care, this benefit will help with costs that aren’t already covered.

Medical and rehabilitation benefits will cover a wide range of expenses if they aren’t covered by the insured’s other insurance options (including public health coverage). That includes things like medical and dental procedures, physiotherapy, prescriptions, and even transportation to and from medical treatment sessions — as long as these things relate to the injuries sustained in the accident.

Attendant care benefits cover reasonable expenses if an injured person needs to hire a caregiver to help them while they’re injured, or if they need to move into a long-term care facility.

Medical, rehabilitation, and attendant care benefits are grouped together under one coverage limit. That limit, by default, is $65,000 for non-catastrophic injuries and $1 million for catastrophic injuries. There are several options available for increasing these limits:

1. Increasing coverage for non-catastrophic injuries to $130,000.
2. Increasing coverage for non-catastrophic injuries to $1 million and coverage for catastrophic injuries to $2 million.
3. Increasing coverage for catastrophic injuries by another $1 million.

By choosing options 2 and 3 together, it would result in $1 million in coverage for non-catastrophic injuries and $3 million for catastrophic injuries.

The full list of covered expenses and limitations is also available in the SABS.

Death and funeral expenses

If the absolute worst should happen and someone dies as a result of a vehicle accident, the death and funeral expenses benefit will provide several forms of compensation:

• $25,000 to the deceased person’s spouse
• $10,000 to each of the deceased person’s dependants
• Up to $6,000 for funeral expenses
• $10,000 to the deceased person’s former spouses, if the deceased was obligated to financially support them

As with other accident benefits, there is an option to expand the coverage available under the death and funeral expenses benefit. With this option, the benefit would pay $50,000 to the deceased’s spouse, $20,000 to each dependant, and provide up to $8,000 in funeral expenses.

Other accident benefits

Accident benefits don’t stop there — there are several other standard and optional benefits available.

Payment for other expenses

There are a number of expenses that accident benefits will cover for an injured person. These coverages are included by default.

• Lost educational expenses will provide up to $15,000 to cover expenses for tuition, textbooks, equipment, or room and board that the insured already paid for an educational program that they can’t continue due to their injury.
• Expenses of visitors covers reasonable expenses for family members or certain other people to visit the insured person while they receive treatment for their injuries. This benefit is available for up to 2 years following the accident if the injury was non-catastrophic, or indefinitely if the injury was catastrophic.
• Housekeeping and home maintenance is a benefit that will cover (predictably) housekeeping and home maintenance costs if the insured person suffers a catastrophic injury. This benefit is limited to $100 per week.
• Damage to clothing, glasses, hearing aids, etc. covers reasonable expenses to replace the insured’s medical or dental equipment (prescription glasses, hearing aids, prostheses, etc.) that was damaged in the accident. It also covers expenses to replace clothing damaged in the accident.
• Cost of examinations covers reasonable expenses for assessments or examinations that the insured needs for things like securing a disability certificate, reviewing a treatment plan, or an assessment of attendant care needs.

Dependant care benefit

This is an optional benefit that isn’t available unless it’s been specifically added to the policy.

The dependant care benefit will pay some additional costs necessary to care for the insured person’s dependants following an accident. To qualify, the insured must have been employed at the time of the accident and must have sustained an impairment as a result of the accident. They also must not be receiving the aforementioned caregiver benefit.

This benefit is limited to $75 per week for one dependant plus $25 for each additional dependant.

Indexation benefit

This is another optional benefit that drivers in Ontario can choose to add to their car insurance policy. The indexation benefit makes it so that several accident benefit limits are annually adjusted based on inflation. The adjustment is based on the Consumer Price Index, so the amount that each limit will change is different each year.

The benefits whose limits can be indexed are:

• Weekly income replacement benefit
• Weekly non-earner benefit
• Attendant care benefit
• Medical and rehabilitation benefits

The adjustment to these limits happens on January 1 each year.

Commonly asked questions

How long are accident benefits paid in Ontario?

Each type of benefit has its own time limitations. Income replacement, non-earner, and caregiver benefits are typically available for up to 104 weeks (2 years) after the accident so long as the insured person continues to suffer impairment from their injuries. Medical, rehabilitation, and caregiver benefits are available for up to 260 weeks (5 years) after the accident so long as they’re needed, though this limit doesn’t apply for catastrophic injuries.

Who can apply for accident benefits in Ontario?

Accident benefits are available to anyone injured in a vehicle accident in Ontario: drivers, passengers, pedestrians, and bystanders.

What are the optional accident benefits in Ontario?

The main optional accident benefits are payment for other expenses, dependant care benefit, and the indexation benefit. There are also several options available for increasing the limits of the standard benefits.

What’s the difference between a catastrophic and non-catastrophic injury?

A catastrophic injury or catastrophic impairment is one that results in paraplegia or tetraplegia, amputation of a limb, loss of vision in both eyes, traumatic brain injuries, or similar impairments that seriously compromise a person’s ability to continue their normal life. The Schedule of Accident Benefits describes the precise definitions and limitations of catastrophic injuries.

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