If you are hurt in a motor vehicle accident in Ontario, you may be entitled to accident benefits. Fault does not decide this. On July 1, 2026, one of the biggest Ontario car insurance changes in years took effect. It is easy to misread if you only catch the headline. This guide covers what SABS actually pays for, what changed, and what to do if a benefit gets denied.
Disclaimer: This article reflects general legal information based on Ontario law as of 2026, including the July 1, 2026 changes to the Statutory Accident Benefits Schedule. It is not legal advice. Every case is unique, and you should consult a qualified personal injury lawyer about your specific situation.
Ontario's statutory accident benefits are governed by the Statutory Accident Benefits Schedule, commonly called SABS. SABS is the no-fault side of Ontario auto insurance. An insurer must pay accident benefits to an insured person hurt in an accident, regardless of fault. Fault still matters elsewhere. A person may also have a separate tort claim against an at-fault person or other responsible party. SABS simply removes the need to wait for a fault finding before getting support. No-fault does not mean automatic approval, though. An insurer can still dispute whether a benefit applies, whether treatment is necessary, or how much is payable.
Accident benefits can reach more than the named policyholder. Drivers, passengers, and people hurt outside a vehicle, including pedestrians and cyclists, may all qualify. Ontario's priority rules under the Insurance Act decide which insurer actually pays. That is a separate question from whether someone is eligible at all. The July 2026 reform did not impose the same narrowed claimant categories on mandatory medical, rehabilitation, and attendant care benefits. Eligibility for those benefits continues to depend on the broader insured-person definition and the other requirements and exclusions in SABS.
These two get confused because they can run at the same time. SABS pays without anyone proving fault. A personal injury claim requires proving fault, and it runs through the courts, not an insurer's claims process. A person can pursue both where the law allows it. Ontario's collateral-benefit rules coordinate compensation from different sources, and they can affect what a lawsuit recovers. How that plays out depends on the type of loss claimed, so accident benefits and tort damages are not simply interchangeable money.
Someone without their own policy, and not listed on anyone else's, can still claim the mandatory medical, rehabilitation, and attendant care benefits if hurt in an accident. After the 2026 changes, this group actually has broader access to the core benefits than to the newly optional ones. Which insurer pays is separate, and it runs through the Insurance Act's priority rules. For an occupant, the rules generally look first to a policy the person is insured under, then the vehicle they were in, then other involved vehicles. Pedestrians and cyclists follow a similar order, usually starting with the vehicle that struck them. Where nothing else recovers, the Motor Vehicle Accident Claims Fund is the last resort.
This group has the widest access. They qualify for the mandatory benefits and for whatever optional benefits their policy carries. A listed driver, in the regulation's own words, is a person named in the policy as a driver of the vehicle. This guide just calls them listed drivers from here on.
Before the reform, standard coverage tracked the broad insured-person definition closely across most benefits. As of July 1, 2026, that stopped being true for the optional ones. They now apply only to the named insured, spouse, dependants, and listed drivers, no matter when the policy renewed. A passenger outside those categories still gets the mandatory core benefits, just not the optional ones, even if the policy includes them.
SABS benefits split into two groups now: benefits that stay mandatory on every policy, and benefits that became optional on July 1, 2026. Access to the optional group depends on your relationship to the policy and whether the coverage was purchased before the accident.
Medical benefits can cover reasonable and necessary treatment payable under SABS, including physiotherapy, occupational therapy, psychological treatment, medication, and transportation to appointments. Rehabilitation benefits cover measures to restore function, like counselling, vocational training, and home or vehicle modifications. Attendant care covers aide or facility support when the impairment is not minor, capped at $3,000 a month for non-catastrophic claims and $6,000 for catastrophic ones. These three benefits share one combined limit: $65,000 for non-catastrophic impairments, $1,000,000 for catastrophic ones. Optional coverage can raise that to $130,000 or $1,000,000, and $2,000,000 for catastrophic claims. A lower $3,500 limit applies under the Minor Injury Guideline, for sprains, strains, and similar soft tissue injuries. A documented pre-existing condition can sometimes justify treatment outside that limit, but it is a specific test, not an automatic exemption. Catastrophic impairment is its own legal designation, not a matter of how expensive treatment gets. It covers things like paraplegia, tetraplegia, certain amputations, total vision loss, a traumatic brain injury meeting defined clinical criteria, or a set level of physical or combined impairment under the regulation's own method. Meeting one of these categories, not spending past a dollar limit, is what unlocks the higher benefit tier.
Income replacement runs at 70 percent of gross income up to $400 a week, with optional buy-ups above that. There is a one-week wait, and the eligibility test gets stricter after 104 weeks. The non-earner benefit is for people who do not qualify for income replacement and who meet the SABS test for a complete inability to carry on a normal life. It pays $185 a week after a four-week wait. Caregiver and housekeeping deserve a closer look than most guides give them. For new business, the legislated standard is now all-impairment, not the old catastrophic-only baseline, though some insurers may still offer an approved catastrophic-only version instead.
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| Benefit | Coverage Status | Who Can Claim It | Standard Coverage |
|---|---|---|---|
| Medical, Rehabilitation & Attendant Care (combined limit) | Mandatory | Broad insured person definition under SABS | Up to $65,000 (non-catastrophic) Up to $1,000,000 (catastrophic) |
| Income Replacement | Optional | Named insured, spouse, dependants, and listed drivers | Up to $400/week (standard option) |
| Non-Earner Benefit | Optional | Same as above | Up to $185/week (standard option) |
| Caregiver Benefit | Optional | Same as above | Up to $250/week for the first dependant, plus $50/week for each additional dependant (standard option) |
| Housekeeping & Home Maintenance | Optional | Same as above | Up to $100/week (standard option) |
| Death Benefit | Optional | Same as above | $25,000 to an eligible spouse $10,000 for each eligible dependant (standard option) |
| Funeral Benefit | Optional | Same as above | Up to $6,000 (standard option) |
Report the accident within seven days, or as soon as reasonably possible after that.
Once notified, the insurer sends an application package, including Form OCF-1, the Application for Accident Benefits. Missing this deadline will not automatically end a claim, but it can delay or complicate one.
The completed application is due within thirty days of receiving it. Serious or ongoing claims often need more medical documentation as the file moves along.
The insurer will approve, adjust, or deny the claim. A denial can be escalated to the Licence Appeal Tribunal's Automobile Accident Benefits Service, generally called LAT-AABS.
Medical, rehabilitation, and attendant care stay mandatory. That has not moved.
Income replacement, non-earner, caregiver, housekeeping, lost educational expenses, visitor expenses, damage to personal items, death, and funeral all became optional for policies entered into or renewed on or after July 1, 2026. Dependant care and indexation round out the full optional list, but they were already optional before this reform, not newly so.
Three separate ideas get blended together, and each answers a different question. For a new policy on or after July 1, 2026, medical, rehabilitation, and attendant care are the only mandatory SABS benefits. All other SABS accident-benefit categories are optional from day one. For a renewed policy, existing benefit amounts generally continue as optional benefits unless the named insured and insurer agree in writing to change them. Separately again, who can actually receive an optional benefit is restricted, as of July 1, 2026, to the named insured, spouse, dependants, and listed drivers, no matter the renewal date. A policy can carry its old benefit amounts forward under the second rule while still losing optional coverage for anyone outside that narrower group under the third.
Ontario drivers now have more decisions to make about coverage that used to come standard. Income replacement, non-earner, caregiver, housekeeping, death, and funeral benefits are no longer automatic on a new policy. Review your coverage rather than assuming everything from your old policy carried over.
Insurers may offer approved bundles of optional benefits instead of selling each one separately. FSRA has said insurers can build bundles around consumer need, subject to filing, approval, fairness, and transparency rules, and bundles can differ between insurers.
For Ontario accidents on or after July 1, 2026, auto insurance became the first payor for most medical and rehabilitation expenses, other than medication, even where a supplementary health plan could otherwise cover it. That plan can include certain employer- or union-sponsored group benefits and individual supplementary health plans.
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| Benefit | Before July 1, 2026 | On or After July 1, 2026 |
|---|---|---|
| Medical, Rehabilitation & Attendant Care | Included with every standard Ontario auto policy. | Still mandatory. Coverage remains available under the standard policy, subject to SABS eligibility rules and benefit limits. |
| Income Replacement | Included with every standard policy. | Optional. Available only if purchased, and only for the named insured, spouse, dependants, or listed drivers. |
| Non-Earner Benefit | Included with every standard policy. | Optional. Same narrowed claimant group applies. |
| Caregiver Benefit | Generally available only for catastrophic impairments under the standard policy. | Optional. New policies now use an all-impairment standard, although some insurers may offer an approved catastrophic-only option instead. |
| Housekeeping & Home Maintenance | Generally available only for catastrophic impairments under the standard policy. | Optional. Follows the same approach as the caregiver benefit. |
| Death & Funeral Benefits | Included with every standard policy. | Optional. Available only where purchased, and only for the named insured, spouse, dependants, or listed drivers. |
Accident benefits did not disappear on July 1, 2026. Medical, rehabilitation, and attendant care remain mandatory, subject to SABS eligibility rules and limits. What changed is that income support, caregiving, housekeeping, and death or funeral coverage now depend on choices made before the accident, and on your relationship to the policy.
Accident benefits are paid without proving fault, and disputes go through the insurer and then LAT-AABS. A personal injury lawsuit requires proving fault, runs through the courts, and can compensate for pain and suffering, which accident benefits cannot. LAT-AABS resolves disputes about entitlement to a benefit or the amount payable. It does not decide fault, property damage, or which insurer is ultimately responsible.
A serious injury can involve both an accident benefits file and a lawsuit at the same time. Where they overlap, Ontario's collateral-benefit rules coordinate the two to prevent recovering the same loss twice. The mechanics depend on the category of loss, not a simple dollar-for-dollar deduction.
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| Feature | Accident Benefits (SABS) | Personal Injury Lawsuit |
|---|---|---|
| Need to Prove Fault? | No. Benefits are available regardless of who caused the accident, provided SABS eligibility requirements are met. | Yes. You must prove another person was legally responsible for your injuries. |
| Who Decides Disputes? | Your insurer first, then the Licence Appeal Tribunal – Automobile Accident Benefits Service (LAT-AABS) if necessary. | The Ontario courts. |
| Can You Recover Pain and Suffering? | No. SABS does not compensate for pain and suffering. | Yes. Pain and suffering damages may be available where the legal requirements are met. |
Late reporting or an incomplete application will complicate a claim before it is even properly considered.
Insurers may dispute medical necessity, refuse to fund treatment, or contest a catastrophic impairment designation.
A claim can be denied because the optional benefit was never purchased, or because the claimant does not fall within the narrower covered-person categories that took effect this July.
A written denial can trigger the limitation period for disputing the benefit, so review the date and contents of the insurer's notice carefully.
Disputes go to LAT-AABS.
An insurer denying a benefit is not the end of the road, even if it feels that way. Sanctuary Lawyers has spent years working against insurance companies, so we understand the tactics used to minimize or deny a claim before we open the file. We take personal injury matters on a no-win, no-fee basis. There are no upfront costs, and we only get paid if your claim succeeds. We keep you informed at every stage, rather than leaving you to guess. If your accident benefits have been denied, reduced, or delayed too long, we can review what happened and help you decide whether a LAT-AABS dispute makes sense.
Here are answers to some of the most common questions we hear about accident benefits and the 2026 changes.
A denied or disputed accident benefits claim does not always mean the process is over. If you have questions about your entitlement or the insurer's decision, our team can review your claim and explain the options available to you.