What are Statutory Accident Benefits (SABS)? A Layman's Guide

When you're involved in a motor vehicle accident in Ontario, it's crucial to be aware of your rights and the support available to you. Accident Benefits under the Statutory Accident Benefits Schedule (SABS) are a set of insurance benefits designed to provide financial and medical assistance to individuals injured in auto accidents. In this article, Campisi will explain the SABS in layman's terms, explaining what it is, what it covers, explain minor injury guidelines, Examinations Under Oath, catastrophic impairment, optional benefits, and how to apply for Accident Benefits.

What are Statutory Accident Benefits?

Accident Benefits are a collection of benefits provided under Ontario's automobile insurance legislation called the Statutory Accident Benefits Schedule (SABS). These benefits are intended to support individuals who sustain injuries or suffer losses due to motor vehicle accidents, regardless of fault. All Ontario motorists are required by law to have automobile insurance that includes these benefits.

What do the SABS Cover?

The SABS provide compensation for a range of accident-related expenses, including:

1. Medical and Rehabilitation Benefits: These benefits cover reasonable and necessary medical treatment, therapy, medications, and rehabilitation services, such as physiotherapy, psychological services and chiropractic care.
   
   
2. Income Replacement Benefits: If you are unable to work due to your injuries, the SABS provide a partial income replacement of up to 70% of your gross income (subject to a maximum weekly limit of $400.00, unless optional benefits have been purchased).
   
   
3. Caregiver Benefits: If you were the primary caregiver before the accident and can no longer provide care due to your injuries, the SABS can compensate you for additional expenses incurred in hiring a caregiver. This benefit is only available to individuals that have suffered a catastrophic impairment.
   
   
4. Attendant Care Benefits: These benefits cover some of the cost of hiring a personal support worker to assist with daily activities if you require ongoing care due to your injuries. This benefit is only available to individuals who have sustained non-catastrophic and catastrophic impairments as a result of the accident. It is not available to individuals that have injuries that fall within the Minor Injury Guideline. The monthly maximum amount payable is $3,000.00 for non-catastrophic impairments and $6,000.00 for catastrophic impairments.
   
   
5. Non-Earner Benefits: If you were not employed at the time of the accident or were enrolled in school at the time of the accident and are unable to carry on a normal life, the SABS can provide you with a weekly benefit after a waiting period of four weeks. The weekly amount is $185.
   
   
6. Death and Funeral Benefits: In the unfortunate event of a fatal accident, the SABS may provide financial support to the surviving spouse, dependents, or estate, covering funeral expenses and other related costs.

With respect to Income Replacement Benefits, Caregiver Benefits and Non-Earner Benefits, you are only entitled to receive payment from one of these benefits. It is also important to note that once you decide on which benefit to receive, you cannot change your selection unless you are later deemed catastrophically impaired.

Minor Injury Guidelines

The Minor Injury Guidelines (MIG) are a set of rules that determine the maximum benefits available for individuals who sustain minor injuries in a car accident. The MIG applies to injuries such as sprains, strains, whiplash-associated disorders, abrasions, contusions, and lacerations.

If your injuries fall within the MIG, the maximum duration for receiving medical and rehabilitation benefits is limited to five years, or until your benefits reach a predetermined monetary limit. The monetary limit for this category is $3,500.

Even if you think your injuries are minor, it is still prudent to consult a personal injury lawyer because if your injuries turn out to be more severe, the insurance company may refuse to place you into the non-catastrophic category. Without a personal injury lawyer you may remain stuck in the MIG without access to proper funding for treatment and care.

Non-Catastrophic Impairment

Non-catastrophic impairment refers to injuries that do not fall within the minor injury guideline but are also not of the severity of a catastrophic impairment. If you are found to have non-catastrophic impairments because of an accident, your policy limits open up to $65,000 that are available for five years, or until your benefits reach the monetary limit. You may also have access to additional benefits such as $3,000 per month for attendant care services. 

Catastrophic Impairment

Catastrophic impairment refers to the most severe and life-altering injuries resulting from a motor vehicle accident. Examples of catastrophic impairments include paraplegia, quadriplegia, amputation, severe traumatic brain injury, and other impairments that significantly impact a person's physical or mental functioning. If you are deemed to have a catastrophic impairment, you may be eligible for enhanced benefits and higher coverage limits under the SABS. There is also no time limitation to access these benefits as they are available for life.

Check out Campisi’s free full Catastrophic Injury guide here for more detailed information.

Optional Benefits

In addition to the mandatory SABS coverage, Ontario drivers have the option to purchase additional coverage known as Optional Benefits. These optional benefits can provide increased compensation for medical expenses, income replacement benefits, and other accident-related costs. It's advisable to consult with your insurance provider to understand the available optional benefits and their costs.

How to Apply for Accident Benefits:

To apply for Accident Benefits, follow these steps:

1. Notify your insurance company: Inform your insurance company about the accident immediately or within seven (7) days and your intention to apply for Accident Benefits. Provide them with the necessary details and documentation.
   
   
2. Complete the Application for Accident Benefits: Your insurance company will provide you with an Application for Accident Benefits form, also referred to as an OCF-1. Fill it out accurately and attach any supporting documents, such as medical reports or police accident reports. If you have trouble completing the form, a PI lawyer can certainly help.
   
   
3. Submit the application: Send the completed application and supporting documents to your insurance company within the specified timeframe. Ensure you retain copies for your records.
   
   
4. To receive certain benefits, you may be required to complete several additional forms. For example, to receive Income Replacement Benefits, you will need your employer to complete an OCF-2, also known as an Employer’s Confirmation Form. You will also need a medical professional to complete an OCF-3, also known as a Disability Certificate. If you are unsure what additional forms you need to complete and provide, contact your insurance company or seek the advice of a personal injury lawyer.
   
   
5. Cooperate with the claims process: Your insurance company may request additional information or assessments to evaluate your claim. Cooperate with their requests and provide the required documentation promptly.  
   
   This may include an Examination Under Oath (EUO), a formal process where an insurance company representative can question you, under oath, about the details of your accident, injuries, and the circumstances surrounding your claim. This process is conducted to gather information and assess the validity of your claim. It's important to cooperate with an EUO as required by your insurance policy, but you can seek legal advice to prepare for this process.
   
   
6. Seek legal advice if needed: If you encounter difficulties during the claims process or have concerns about your entitlements, consider consulting a personal injury lawyer who specializes in motor vehicle accidents.
   
   Campisi has seen firsthand what happens when clients try to go through the claims process alone. They often get denied income replacement benefits, but once they retain Campisi, we have turned the situation around and get them years’ worth of income related benefits or other benefits that the otherwise would have never seen had they not consulted us.  In short, don’t go through the process without the proper support.

Need More Help with SABS?

Statutory Accident Benefits (SABS) are an essential safety net for individuals injured in motor vehicle accidents in Ontario. Understanding your rights and the benefits available to you can help ensure you receive the necessary support for your recovery. 

By familiarizing yourself with SABS, you can navigate the post-accident period more confidently and secure the assistance you need. And if you need support with your SABS claim, consulting a credible personal injury firm like Campisi is always a good option to ensure you receive fair and just compensation.

Read more about Settling Your SABs Accident Benefit Claim.