If you’re re-evaluating your accident benefits claim or are concerned that a quick settlement might have left some of your needs unmet, here are a few important points to consider.

Ontario’s accident benefits system is governed by the Statutory Accident Benefits Schedule (SABS), which has undergone several amendments since its introduction. The version of the SABS that applies to your claim depends on the date of your accident. Each version offers different types and amounts of benefits, so understanding which one applies can have a significant impact on your recovery and the support available to you.

For older claims, sometimes referred to as "cold cases," you may still be able to get the support you need if your claim was denied or not fully addressed.". Reopening these cases could help ensure you receive the benefits you’re entitled to.

Additionally, settling a claim quickly can sometimes mean missing out on comprehensive support. Reviewing your settlement under current SABS regulations is essential to ensure all your needs are met.

Statutory Accident Benefits Schedule Impacts Before and After Bill 164

Soon after the SABS was launched, a major challenge faced both the injury victims and their insurance companies. While the system was designed to make sure claimants received timely access to treatment, income replacement and other necessary benefits, insurers would only provide funding when they received medical evidence supporting the claim. In all but the clearest cases, it could take weeks or months to satisfy the insurance adjuster that a requested benefit was reasonable and necessary to the victim’s recovery or support – often only after lawyers got involved.

To provide some context, Bill 164 was introduced in 1994 and brought substantial changes to the accident benefits system. It replaced the original SABS, introducing new regulations and benefit levels. Since then, further updates to the SABS have adjusted the scope and scale of benefits available. Knowing which version of the SABS applies to your case is essential for understanding your entitlements.

If you're unsure which version of SABS applies to your claim or want to explore the possibility of increasing your benefits, reach out for a free consultation. Our team is here to help you understand your entitlements and ensure you receive the support you deserve.

Bill 164 has several unique features that can contribute to the potential value of revived “cold case” claims from accidents between January 1994 and October 1996 so those of you who where injured during this time might be able to receive a higher amount of benefits!

Ontario Accident Benefits Chart; SABS Before and After Bill 164

Indexation means that benefits calculated at a specific time will be adjusted annually as the cost of living increases.

Because of these unique features, “cold case” claims under Bill 164 can lead to life-changing settlements for long-suffering accident victims.

Examples of SABS benefits after Bill 164 and its’ Impact on Accident Survivors

Income Replacement Benefits (IRBs)

Suppose you were seriously injured in 1997 at age 30 and were never able to return to work. Your net weekly income at that time was determined to be $1,000/week. You did not purchase optional indexation or a higher IRB limit. Therefore, your IRB would be capped at $400/week and would stay at that level no matter how long you continued to receive it, even to 2024 and beyond. This would have a crippling effect on your financial wellbeing.

On the other hand, if the accident happened between January 1994 and October 1996, you would initially receive $900/week (90% of your net weekly income) AND it would increase annually along with inflation (Note: for 2024, the “indexation percentage” is 3.8%).

Education Disability Benefits (EDBs)

Education Disability Benefits were available for injured claimants who were less than 16 years old at the time of the accident, were either enrolled full-time as students or had completed their education within the previous year and were not employed. This benefit was payable for at least 2 years post-accident after the victim reached age 16. In 1995, the Average Weekly Earnings in Ontario was around $540/week, and the EDB would have been around $270/week. So long as the claimant remained eligible, this amount would also increase annually with inflation.

Injury victims in this category under other versions of the SABS could only be eligible for Non-Earner Benefits, capped at $185/week, exclusively for the most severely injured claimants.

Loss of Earning Capacity Benefits (LECBs)

Under Bill 164, Loss of Earning Capacity Benefits were available to accident victims who were receiving a weekly disability benefit 104 weeks (2 years) after the accident, including: income replacement benefits, education disability benefits, caregiver benefits, or the weekly benefit for injury victims who do not fit into one of these categories, called “Other Disability Benefits”. LECBs are paid in recognition of the permanent impact on the victim’s employability and earning potential. Designated Assessment Centres (DAC) would conduct two mandatory review assessments (3 and 8 years after first receiving LECBs). These assessments allowed the insurer to adjust the amount of the benefit if the claimant’s circumstances had changed. Otherwise, they had no authority to challenge ongoing payment. On the other hand, the injury victim could seek reassessment at any time if their condition deteriorated over time.

LECBs are calculated by determining the claimant’s pre-accident earning capacity, using either the net weekly income of the claimant or using the Average Weekly Earnings to establish their Pre-Accident Earning Capacity. Next, an assessment at a Designated Assessment Centre would determine the claimant’s Residual Earning Capacity (up to $1,000), was payable as a weekly benefit, potentially for life, and subject to automatic indexation.

So, if an accident victim was earning a net income of $1,000/week, and after rehabilitation was eventually able to return to the same employment on a part-time basis making $500/week net, the Loss of Earning Capacity Benefit would be $500 weekly to age 65 with annual indexation increases. After age 65, the benefit would continue at a reduced rate.

Under Bill 164, at the 2-year mark, the insurer was required to make an LECB offer, even if ongoing entitlement to weekly benefits was in dispute until after the 104 weeks were already past.

If you were involved in a car accident between 1994 and 1996, your case may be worth far more than you were led to believe. Many of you should have been offered Loss of Earning Capacity Benefits (LECBs), which could provide lifelong compensation. However, your insurance company might have prematurely terminated your benefits or underpaid your claim—often without a valid reason.

Some common tactics used by insurance companies include:

• Cutting off benefits without any explanation;
• Relying on biased medical evaluations; and
• Using surveillance to deny your rightful compensation.

In our experience, numerous legitimate claims for these benefits still exist that have not been investigated. Many of you have continued to suffer with serious ongoing impairments for decades that have reduced your earning potential and drastically impacted your lives when your insurance company should have been providing accident benefits to ease the burden.