What are Medical and Rehabilitation Benefits Under Ontario’s Accident Benefits Schedule?

By Steph Walsh in Accident Benefits (SABS) on August 16, 2024

Ontario’s Statutory Accident Benefits Schedule (SABS) is a vital lifeline for those who have suffered injuries due to a motor vehicle collision. This comprehensive system offers essential financial assistance and coverage, ensuring that accident victims can access the resources they need to facilitate their recovery and rebuild their lives. 

However, the intricacies of the accident benefits landscape can be extremely complex, with varying levels of support available depending on the severity of the injuries sustained. For anyone grappling with the consequences of a road mishap, it is imperative to grasp the nuances of these benefit tiers to ensure they receive the appropriate level of aid during their healing journey. 

By familiarizing yourself with the different facets of accident benefits in Ontario, you can navigate the post-accident realm with a bit more clarity and confidence and make better, informed decisions that prioritize your well-being and future prospects.

If you have any questions, please call our Hamilton personal injury lawyers today at 1-844-LALANDE if you have any questions regarding the accident benefits schedule in Ontario or require any clarification. 

What are Accident Benefits?

Accident benefits are a type of no-fault insurance coverage that is mandatory for all automobile insurance policies in Ontario. When someone is injured in a motor vehicle accident, regardless of who was at fault, they are entitled to receive certain benefits from their own insurance company to assist with their recovery. These benefits are outlined in the Statutory Accident Benefits Schedule (SABS), which is a regulation under Ontario’s Insurance Act.

The specific benefits available under the SABS include income replacement for those who cannot work due to their injuries, payments for medical and rehabilitation expenses, attendant care for those who need assistance with daily tasks, and other benefits such as housekeeping and home maintenance. The amount and duration of these benefits depend on the severity of the injuries suffered, with more significant injuries warranting higher levels of benefits. In the event of a dispute between the injured person and their insurance company regarding entitlement to benefits or the amount of benefits, the SABS sets out a dispute resolution process that can involve mediation, neutral evaluation, arbitration or court proceedings.

Who can Access Accident Benefits?

In Ontario, anyone who is involved in a motor vehicle accident is potentially entitled to accident benefits, subject to certain conditions and exclusions. This includes:

• The named insured on an Ontario automobile insurance policy, as well as their spouse, dependants, and anyone specified as a driver on the policy, if they are involved in an accident anywhere in Canada or the United States.
• Any occupant of an insured vehicle involved in an accident in Ontario, regardless of whether they are a resident of the province.
• Pedestrians or cyclists who are struck by an insured vehicle in Ontario, regardless of whether they are a resident of the province.
• Occupants of an uninsured vehicle or pedestrians/cyclists struck by an uninsured vehicle if they are a resident of Ontario or were a resident in the 60 days prior to the accident. In these cases, the claim is made against the Motor Vehicle Accident Claims Fund (MVACF).

However, some exclusions may disentitle a person from receiving accident benefits. These include accidents that occur while the person is engaged in certain criminal acts, while operating a vehicle without a valid driver’s licence, or while driving a vehicle exempt from insurance requirements, such as an off-road vehicle. Additionally, those who are entitled to workplace insurance benefits arising from the accident will have their accident benefits reduced by the amount of the workplace benefits.

What are Medical and Rehabilitation Benefits? 

Among the available benefits covered under SABS are medical and rehabilitation benefits. These are extremely common claims following a car accident, as most accidents result in injuries, and many injuries require treatment, therapy, and rehabilitation. The accident benefits will cover what OHIP does not. You can have a comprehensive look at the coverage here, but some of the most common medical benefits claimed include: 

• The insurer is liable to pay for all reasonable and necessary expenses incurred by or on behalf of an insured person as a result of an accident for medical and rehabilitation benefits (Section 14).

1. Medical benefits include all reasonable and necessary expenses for medical, surgical, dental, optometric, chiropractic, psychological, occupational therapy or speech-language pathology services, nursing, hospital, ambulance, prescription drugs, dental and optical services, dentures, hearing aids, wheelchairs/mobility devices, prostheses, and other medical equipment and supplies (Section 15).
2. Rehabilitation benefits include all reasonable and necessary expenses for life skills training, family counselling, social rehabilitation counselling, financial counselling, employment counselling, vocational assessments, workplace/home modifications, vehicle modifications, and other goods and services to reduce or eliminate the effects of any disability and facilitate reintegration into the family, society and the labour market (Section 16).
3. Case manager services are provided if agreed by the insured person and the insurer to coordinate medical and rehabilitation goods and services for the insured (Section 17).

Medical and Rehabilitation Benefits Limits: How Much am I Entitled to? 

Ontario’s Statutory Accident Benefits Schedule (SABS) provides a comprehensive system of benefits for individuals who have been injured in a motor vehicle accident, regardless of fault. 

The SABS divides benefits into three distinct levels based on the severity of the impairment suffered by the insured person: the Minor Injury Guideline (MIG), Non-Catastrophic Impairment, and Catastrophic Impairment. Each level has its own specific criteria, benefit limits, and time frames. The following is a summary of these three levels of benefits:

Minor Injury Guideline (MIG): This applies to minor injuries as defined in the SABS, such as sprains, strains, whiplash, contusions, abrasions, lacerations or subluxations. The maximum limit for medical and rehabilitation benefits for minor injuries is $3,500.

Non-Catastrophic Impairment: This applies to injuries more severe than those covered under the MIG but do not meet the definition of catastrophic impairment. For accidents occurring on or after June 1, 2016, the maximum combined limit for medical, rehabilitation and attendant care benefits for non-catastrophic impairments is $65,000. These benefits are payable for up to 5 years following the accident.

Catastrophic Impairment: Applies to the most serious injuries, as defined in the SABS (e.g., paraplegia, quadriplegia, severe brain injuries, certain amputations, blindness). For accidents occurring on or after June 1, 2016, the maximum combined limit for medical, rehabilitation and attendant care benefits for catastrophic impairments is $1,000,000. These benefits are payable for the lifetime of the insured person.

It’s important to note that the specific limits and time frames for these benefits may vary depending on the date of the accident, as the SABS has undergone several amendments over the years. The information provided here is based on the SABS in effect for accidents occurring on or after June 1, 2016.

Also, while these examples can help you understand the difference between types of injury under these benefits, the final classification is dependent upon the circumstances and the results of medical assessments. It’s also important to note that these limits are combined limits for medical, rehabilitation, and attendant care benefits. 

This is another instance where involving a Hamilton personal injury lawyer in your case can make all the difference. Insurance companies can have you undergo various assessments that produce incorrect or incomplete results, giving them a reason to pay less than you deserve. A personal injury lawyer can help you gather sufficient medical evidence to prove the severity of your injuries and connect you with the right medical professionals to help. 

Can I Increase my Medical and Rehabilitation Benefits? 

Yes, there are optional benefits that you can add to your policy for catastrophic and non-catastrophic injuries. While the basic Accident Benefits are automatically included, you can pay for higher limits, though no increases are available for minor injuries. 

• You can increase the standard coverage for non-catastrophic injuries from  $65,000 to $130,000.
• You can increase the standard coverage for catastrophic injuries from $1,000,000 to $2,000,000.

These increased limits are still combined limits for medical, rehabilitation, and attendant care. 

Navigating the complexities of the Statutory Accident Benefits Schedule (SABS) can be extremely complex and overwhelming, especially when you’re dealing with the physical and emotional aftermath of a motor vehicle accident. Our compassionate and experienced Hamilton personal injury lawyers understand the challenges you face and are here to help. We offer free consultations to review your case, advise you of your rights, and help you understand the benefits. Our goal is to alleviate your financial worries so that you can focus on your recovery. If we work together, you can trust that we will handle the legal complexities, negotiate with insurance companies, and represent your interests every step of the way. You won’t have to pay any upfront fees – we only get paid if we successfully resolve your case. If you or a loved one has been injured in an accident, please don’t hesitate to call us from anywhere in Ontario at 1-844-LALANDE or local in the GTA/ Hamilton area at 905-333-8888