Have you been injured in a car accident in Ontario? Whether you are at fault or not, we can help you obtain accident benefits. If you are unable to work following an accident or require medical and rehabilitation treatment, we can help you access income replacement benefits as well as benefits to pay for your treatments. If you have sustained a catastrophic injury in a car accident, we can help you access meaningful benefits for your medical, rehabilitation, and attendant care needs.

For a free consultation regarding your claim for accident benefits, call Hillier & Hillier at 905 453 8636 or click here to submit an online request for a free consultation.

What Are Accident Benefits?

Accident benefits are available to individuals who have been injured in a car accident.

These benefits are available to you whether you are at fault for an accident or not. You do not need to commence a lawsuit to access these benefits.

What Accident Benefits Are Available?

This depends on when you last renewed your auto policy and whether you purchased optional benefits for renewals after July 1, 2026.

If your current auto policy was renewed before July 1, 2026, then the following benefits may be available to you:

• Medical, Rehabilitation, and Attendant Care benefits that are reasonable and necessary to your recovery up to:

  • $3,500 if you sustained minor injuries which must be used within 5 years from the accident

  • $65,000 if you sustained non-minor and non-catastrophic injuries which must be used within 5 years of the accident

  • $1,000,000 if you sustained catastrophic injuries for life

• Income Replacement Benefits (IRBs) up to the lesser of $400 or 70% of your pre-accident gross weekly income after deductions for other income replacement assistance (LTD benefits, short term disability, CPP disability). You may receive this benefit provided you are substantially unable to engage in the essential tasks of your employment or self-employment for the first 104 weeks after you are injured. After 104 weeks, you may receive this benefit if you are completely disabled from performing any employment or self-employment for which you are suited by way of education, training, or experience.

• If you were not working at the time of the accident and were not employed in the 26/52 weeks before the accident, then a non-earner benefit of $185 per week for two years.

• A caregiver benefit if your injuries prevent you from caring for individuals who were dependent upon you at the time of the accident (e.g., children). This benefit will cover reasonable and necessary expenses incurred to provide care to your dependants up to $250 per week for the first person in need of care; and $50 per week for each additional person in need of care. Again, you may receive this benefit if you are substantially unable to engage in your caregiving activities for the first 104 weeks after your injury. After 104 weeks, you may receive this benefit if you are completely unable to carry on a normal life.

*You must elect to receive an income replacement benefit, a non-earner benefit, or a caregiver benefit. You may only receive one of these benefits.

• Reimbursement for lost educational expenses up to $15,000 if your injuries prevented you from returning to and completing an educational program in which you were enrolled at the time of the accident.

• Reimbursement for damaged clothing and expenses incurred by visitors who come to see you in hospital.

• A death benefit of up to $25,000 to the insured’s spouse, and $10,000 to each dependant, and a funeral benefit to cover the costs of a funeral up to $6,000.

• A housekeeping benefit of up to $100 per week for reasonable and necessary housekeeping and/or home maintenance expenses if the person sustains a catastrophic impairment as a result of the accident and the person is substantially unable to perform their housekeeping and home maintenance tasks. You may also receive this benefit if you have not sustained a catastrophic impairment but purchased an optional housekeeping benefit.

Note that the amount of available benefits may be higher if you purchased optional benefits. You may purchase an optional IRB of $800 or $1200 per week, you may purchase optional medical, rehabilitation, and attendant care limits of $1,000,000 for non-minor and non-catastrophic injuries, or $3,000,000 if you sustained a catastrophic injury. 

What If I Renewed My Insurance After July 1, 2026?

There will be drastic changes to your available benefits if you renewed your auto policy after July 1, 2026, and did not purchase any optional benefits.

As of July 1, 2026, the law (Statutory Accident Benefits Schedule) was amended. The result is that only the following benefit is automatically included in your insurance:

• Medical, Rehabilitation, and Attendant Care Benefits that are reasonable and necessary to your recovery up to:

  • $3,500 if you sustained minor injuries

  • $65,000 if you sustained non-minor and non-catastrophic injuries

  • $1,000,000 if you sustained catastrophic injuries

The following benefits will not be provided UNLESS you have purchased optional insurance including these benefits:

• Income Replacement Benefit

• Non-Earner Benefit

• Other Expenses for damage to clothing and visitor expenses

• Lost Educational Expenses

• Death and Funeral Benefits

• Caregiving Benefit

• Housekeeping Benefit

The effect of the amendment to the law is that you will need to pay more for the same coverage that existed prior to July 1, 2026. For more information on the changes to your insurance coverage, click here.

How Do I Know If My Injuries Are Minor, Non-Catastrophic, or Catastrophic?

The Statutory Accident Benefits Schedule defines minor injuries, non-catastrophic injuries, and catastrophic injuries.

Minor injuries, which entitle you to $3,500 for reasonable and necessary medical expenses, are defined as: sprains, strains, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae. This definition includes partial tears of ligaments or partial dislocations of a joint. It is important to note that even if you initially sustain one of these injuries, your injuries may be later classified as non-minor entitling you to $65,000 in medical, rehabilitation, and attendant care expenses. This may occur, for example, if you develop chronic pain.

Catastrophic injuries, which entitle you to housekeeping benefits and $1,000,000 in reasonable and necessary medical, rehabilitation, and attendant care expenses, are defined to include:

• paraplegia or tetraplegia;

• severe impairment of mobility or use of an arm or amputation;

• loss of vision of both eyes;

• traumatic brain injuries that meet certain criteria;

• other physical or a combination of physical impairments that results in a 55% or more physical impairment of the “whole person;”

• a mental or behavioural impairment, excluding traumatic brain injury, that results in a 55% or more impairment of the whole person;

• an impairment that results in three or more marked impairments in three or more areas of function OR an extreme impairment in one or more areas of function.

The above-listed injuries must typically meet additional disability-related criteria to meet the definition of catastrophic impairment.

Non-Catastrophic and Non-Minor Injuries, which entitle you to $65,000 in reasonable and necessary medical, rehabilitation, and attendant care expenses are injuries that do not meet the above definitions of minor or catastrophic injuries. These typically include but are not limited to fractures, psychological injuries, completely torn ligaments, whiplash injuries that demonstrate neurological signs, chronic pain, concussions, brain injuries that do not meet the definition of catastrophic impairments.

If you and your insurer disagree as to the classification of your injuries, and consequently the amount of medical, rehabilitation, and attendant care benefits to which you may be entitled, you may bring an application to the License Appeal Tribunal for a legal determination on this issue.

How Much Will I Receive in Income Replacement Benefits?

Assuming you meet the applicable disability test (substantial inability to work in the 104 weeks following your injury, and a complete inability to do any work past the 104 week mark), you may be entitled to a weekly income replacement benefit up to the lesser of 70% of your pre-accident gross weekly income, less other income assistance, or $400.

If you have returned to part-time work and are earning less, the payable income replacement benefit will nonetheless be further reduced by 70% of your post-accident income. Essentially if 70% of your post-accident income exceeds your payable IRB, whether it be $400, $800, or $1,200, the IRB will be reduced to zero.

Other income assistance includes other supplemental income benefits that you receive from other sources such as a long-term disability plan, or CPP disability.

Calculating your income replacement benefit involves the following steps:

1. determine 70% of your gross weekly income at the time of the accident

2.  deduct “other weekly income assistance” from 70% of your gross weekly income

3.  the insurer pays the resulting number UP TO $400

4.  deduct 70% of post-accident income from the payable IRB

For example, assume an individual was earning $2,000 per week prior to the accident. As a result of the accident, they are no longer able to work and are receiving $800 per week from a long-term disability work plan. The IRB will be calculated as follows:

1.  calculate 70% of gross weekly income: 70% of $2,000 = $1,400

2.  deduct other income assistance: $1,400 - $800 = $600.

3.  The payable IRB is the lesser of $400 or $600 = $400.

4.  The individual is not working and not earning any income to deduct from the payable IRB.

The insurer will pay a $400 IRB. Note that if the individual obtained optional IRB insurance, increasing the maximum benefit to $800, then the individual would receive the entire $600 shortfall calculated above.

Now, assume the same individual returned to part-time work but no longer received long-term disability, and earned approximately $900 per week in post-accident income. The IRB would be reduced to zero as follows:

1.  70% of $2,000 = $1,400

2.  There is no other income assistance to deduct.

3.  The payable IRB is $400.

4.  However, the payable IRB of $400 is reduced by $630 (70% of $900) to zero.

In the above example, if the individual purchased optional IRBs of $1,200 a week, then they may be entitled to a benefit of $570 (payable IRB = $1,200 - $630).

In some cases, your IRB may be reduced to zero depending on your pre-accident income and the amount of other income assistance you receive after the accident. This typically occurs where a person’s other income assistance is equal to or exceeds 70% of their pre-accident weekly income.

How Do I Calculate My IRB If I Am Self-Employed?

You may still be entitled to an IRB provided that you meet the same disability test mentioned above (substantially unable to perform your self-employment in the first 104 weeks after your injury and completely unable to perform any work for which you are suited after 104 weeks).

Calculating your IRB as a self-employed person involves the following steps:

1.  Determine your net business income or loss from your last completed taxation year and divide this by 52 to determine your gross weekly business income or loss.

2.   Multiply your gross weekly business income or loss by 70%. Your IRB will be 70% of your gross weekly business income up to $400, unless you purchased optional benefits.

3.  If you continue operating your business after the accident at a loss because of the injuries you sustained, then add 70% of your weekly loss to the amount above, again up to a maximum IRB of $400 per week unless you have optional benefits.

For example, assume you are operating a business earning $1,000 in gross weekly business income, and you are unable to continue this business due to the accident. You must then calculate 70% of your gross weekly business income, which is $700. Your payable IRB will be $400 unless you purchase optional benefits of at least $800 in IRBs in which case your payable IRB would be $700 per week.

In another example, assume you started a business at the time of the accident and were operating the business at a weekly loss of $100. Assume that as a result of your injuries you are now incurring a weekly loss of $400.  Arguably, your loss caused by the accident would be $300 per week, as you were already incurring $100 in losses per week, and then an additional $300 in losses after the accident for a total of $400 in weekly losses. This would result in an IRB of $210 per week ($300 x 70%).

The IRB for self-employed individuals is often calculated by an accountant paid for by your AB insurer. If you disagree with the accountant’s calculations, then you may obtain calculations from an accountant of your choice, and your insurer will pay up to $2,000 plus HST for this other report.

What Happens to My IRB When I Turn 65?

When you turn 65, your IRB will undergo a significant “ramp-down” and be reduced. The ramp-down occurs based on the following formula:

C x 0.02 x D

"C" represents your weekly IRB immediately before the adjustment, and "D" is the lesser of 35 and the number of years the person qualified for the benefit.

For example, assume an individual turned 65 and had been receiving a weekly IRB of $400 per week for a period of 40 years. The new IRB will be $280 based on the following calculation:

400 x 0.02 x 35 = $280

Where Do I Apply?

You can access these benefits by applying to one of the following:

• Your own insurance company

• If you do not own a vehicle, then the insurer of your spouse’s vehicle or the insurer of a person upon whom you are dependent

• If the above do not apply, you may apply to the insurer of a company vehicle to which you have regular access

• If none of the above apply, you may apply to the insurer of the vehicle in which you were an occupant

• If none of the above apply, and you were not in a vehicle at the time of the accident, then you may apply to the insurer of any other vehicle involved in the accident

• If none of the above apply, then you may apply to the Motor Vehicle Accident Claims Fund.

How Do I Apply for Accident Benefits?

You may apply for accident benefits by submitting an OCF-1 Application for Accident Benefits. You will also be required to submit additional forms such as an OCF-3 Disability Certificate completed by your doctor to obtain income replacement benefits.

When Do I Apply?

You must notify your insurance company of the accident within seven days, or as soon thereafter as practicable, and submit an OCF-1 Application for Accident Benefits within 30 days of the accident, or as soon thereafter as practicable.

How Do I Use My Medical, Rehabilitation, and Attendant Care Benefits?

Your treatment provider will submit a treatment plan (OCF-18) to your insurance company who will consider whether the plan is medically reasonable and necessary. If it is, then your insurance company will approve the treatment plan. You will then be able to proceed with that treatment. Your provider will bill the insurance company directly for this treatment, and your insurer will pay your provider’s invoice.

The key rule is that all treatment must be approved in advance, otherwise your insurer may not have to pay for such treatment. For example, if you obtain several months of physiotherapy treatment without first submitting a treatment plan for your insurer’s approval, you may not be reimbursed for that treatment.

What If My Insurer Denies a Benefit?

Your insurer may deny a benefit for many reasons, some of which include but are not limited to the following:

• They may deny treatments costing more than $3,500 if you sustained minor injuries;

• They may deny you an IRB, housekeeping benefit, or caregiver benefit on the basis that they do not believe that you meet the applicable disability test;

• They may deny an IRB if their accountant has determined your IRB is zero

• They may deny treatment that they do not believe is reasonable and necessary to your recovery;

• They may deny that you sustained a catastrophic injury.

Whatever the reason for the denial, you should consult with a lawyer to determine whether your insurance company has properly denied a benefit. In the event your insurer has improperly denied a benefit, you may apply to the Licence Appeal Tribunal and bring a formal proceeding to overturn the denial. It is worth noting that even if you are unsuccessful in overturning the denial, you will not have to pay costs to your insurance company for unsuccessfully disputing the denial in this proceeding, except in very rare circumstances.

You have two years from the date of the denial to initiate an application to the Licence Appeal Tribunal, failing which you will lose your right to challenge the denial.

Expect Medical Assessments

Your insurer is entitled to have you assessed by their medical assessors to determine your ongoing eligibility to certain benefits. You will need to comply with your insurer’s requests for you to attend these assessments, otherwise you may lose your entitlement to benefits. Note that your insurer cannot assess you whenever they please, but only so often as is reasonably necessary to determine your ongoing entitlement to benefits.

Can I Receive Accident Benefits and Sue the At-Fault Driver?

Yes, in fact you should apply for accident benefits if you also plan to sue the at-fault driver. Otherwise, the at-fault driver might be able to reduce the amount of damages you recover by accident benefits that you could have received but did not apply for. In other words, your compensation in a lawsuit may be reduced by benefits that you did not receive.

As well, you may apply for accident benefits even if you are at fault for the accident.

Do I Need a Lawyer for My Accident Benefits Claim?

Yes. Individuals who start their own accident benefits claims are quickly overwhelmed by the paperwork and forms involved in pursuing this claim. Legal knowledge and mastery of the Statutory Accident Benefits Schedule is also required to ensure that you receive all available benefits, understand the process for obtaining treatment, and successfully pursue appeals against your insurer at the Licence Appeal Tribunal. There are also legal rules of evidence at the Licence Appeal Tribunal that most individuals do not understand.

As well, if you have sustained a catastrophic injury, then retaining a lawyer is even more important.

Can I Settle My Accident Benefits File?

Yes, your insurer may consider offering you a lump sum of money to settle your accident benefits file. There are certain advantages and disadvantages to doing so and you should consult with a lawyer before settling your accident benefits claim.

What Is Hillier & Hillier’s Fee for My Accident Benefits File?

We do not charge an up-front fee to assist with your accident benefits file.

However, if we settle your accident benefits claim, we charge a maximum fee of 20% of the amount recovered, plus HST.

Frequently Asked Questions

Q. Can I Receive Benefits If I Don’t Have Insurance?

A. Yes, if you do not have insurance then you can apply to one of the following insurers:

• If you do not own a vehicle, then the insurer of your spouse’s vehicle or the insurer of a person upon whom you are dependent

• If the above do not apply, you may apply to the insurer of a company vehicle to which you have regular access

• If none of the above apply, you may apply to the insurer of the vehicle in which you were an occupant

• If none of the above apply, and you were not in a vehicle at the time of the accident, then you may apply to the insurer of any other vehicle involved in the accident

• If none of the above apply, then you may apply to the Motor Vehicle Accident Claims Fund.

Q. Can I Receive Accident Benefits If I Caused the Accident?

A. Yes. The availability of accident benefits is based on your involvement in an accident, not whether you were at fault or not.

Q. Can a Passenger Claim Accident Benefits?

A. Yes, from their own insurer. If they do not have insurance, then from their spouse’s insurer or the insurer of a person upon whom they were dependent, or the insurer of a company vehicle to which they have regular access. Alternatively, if none of these apply, they can claim accident benefits from the insurer of the vehicle in which they were a passenger. If there is still no insurance, they can claim accident benefits from the insurer of another vehicle involved in the accident. If there is still no insurance, their only resort is to claim accident benefits from the Motor Vehicle Accident Claims Fund.

Q. Can a Pedestrian or Cyclist Claim Accident Benefits?

A. If they were involved in an accident with an automobile, then yes, they may claim accident benefits from their own insurer. If they do not have insurance, then from their spouse’s insurer or the insurer of a person upon whom they were dependent, or the insurer of a company vehicle to which they have regular access. Alternatively, if none of these apply, they can claim accident benefits from the insurer of the vehicle in which they were a passenger. If there is still no insurance, they can claim accident benefits from the insurer of another vehicle involved in the accident. If there is still no insurance, their only resort is to claim accident benefits from the Motor Vehicle Accident Claims Fund.

Why Hillier & Hillier?

At Hillier & Hillier we leverage our large network of medical and rehabilitation professionals to help you obtain appropriate treatment. These professionals will also bill your insurer directly so that the cost of treatment does not fall to you. Our office will ensure all paperwork and forms are completed on time.

We also invest significant amounts into your claim to ensure that you receive a designation of catastrophic impairment where warranted. The lawyers at Hillier & Hillier also have extensive experience successfully appearing at the Licence Appeal Tribunal to overturn insurers’ denials of our clients’ benefits.

We will also negotiate with your insurer on your behalf to obtain a meaningful settlement with which you are satisfied.

Make the most of your accident benefits claim by calling Hillier & Hillier at 905 453 8636 or submitting an online request for a free consultation by clicking here.