What are Accident Benefits for a "Cold Case"?

If you have been involved in an accident, knowing your rights and working with your insurance company to receive necessary benefits or settle your claim can be very challenging. Thankfully, accidents are relatively uncommon. However, this means the whole process is unfamiliar. The rules of the no-fault insurance system are complicated, and it seems as if they are constantly changing. It is not surprising that many people eventually tire of battling their insurance companies and choose to move on with their lives without getting the settlements they deserve.
At Campisi LLP, we call these old, unsettled claims “Cold Cases.”  Just because an accident may have happened long ago, doesn't necessarily mean you are no longer entitled to accident benefits. In an attempt to help eligible claimants, we have prepared a guide to help outline the kind of support to which you may be entitled.

At Campisi, our first priority is to invest our expertise, time and resources into getting you and your family the timely, quality care you deserve.

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What is No-Fault Insurance?

In 1990, the Ontario government introduced the “no-fault” accident benefits regime. Conceptually, the no-fault system makes each insured person’s own insurance company responsible for providing them with accident benefits like income replacement, treatment and attendant care. In exchange for more restricted rights to seek compensation against at-fault drivers, the no-fault system aims to provide efficient and cost-effective access to necessary benefits for everyone, regardless of who caused the accident. 

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What is the SABS?

The Statutory Accident Benefits Schedule, also referred to as SABS, is a form of no-fault insurance. It is mandatory and included as standard automobile coverage. Certain benefits are available to anyone injured in a car accident, regardless of who is at fault. They are regulated under the Ontario Insurance Act.

Vehicle accident injuries

Accident Benefits

No-fault accident benefits have been around for more than 30 years. In that time, there have been several versions of the regulation that set out the rights and obligations on you and your insurance company, and which specific benefits are available.

Generally, under both the current version of the Statutory Accident Benefits Schedule (SABS), you have two years to commence a dispute with your insurer after a denial of benefits. This was also true under the earlier versions of the SABS. In order to trigger the two-year time limit, the denial must be “clear and unequivocal”. In a multitude of past and current accident benefits claims, insurance companies have denied benefits without providing clear and unequivocal reasons justifying the decision. In these cases, the two-year limitation has not yet started to run, and can still be challenged. This holds true many years after the application for benefits was denied, and even for benefits denied under previous versions of the SABS.

Other important information

Other important information

If your insurance company EVER denied your application for Income Replacement Benefits, Attendant Care, Housekeeping, Rehabilitation or other benefits, you might be able to overturn the denial and receive the outstanding amounts with interest. Depending on the specific benefit, you might be entitled to necessary and long overdue treatment, care, or income replacement.

We encourage you to review your older accident benefits claims and the relevant version of the SABS. At Campisi LLP, we specialize in resolving older accident benefits disputes with a proven track record of success in serious cases including catastrophic impairment claims. We are pleased to offer a free, no-obligation consultation to review whether the insurer’s denial was clear and unequivocal.



Check Your Entitlements

We have prepared a free, detailed overview of no-fault benefits law as it has evolved since its introduction. It is a resource for accident victims involved in collisions a long time ago who are having difficulty finding information on their rights and how to access them. Look for the section of this guide that pertains to the date of your accident, so you can understand your rights and potential entitlement to benefits.


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How To Claim Your Accident Benefits

Regardless of when your accident happened, you are required to use OCF claims forms, details of which can be found here.

All disputes are now heard by the License Appeal Tribunal (LAT). If you intend to commence a claim yourself, you can access the LAT here.


OCF Forms

Personal Injury Law Firm for the Seriously Injured

At Campisi, we care fiercely for our clients, giving them the support they need and winning the settlements they deserve. If you've been injured or hospitalized due to an accident in Ontario, it is important that you know your rights and get the best legal representation possible. Contact us now for immediate support.

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The Campisi Difference

Why Choose Campisi?

A champion with heart

When you’re a victim of an accident, everything can seem upside down. You need someone who cares enough to help you through the process, but also someone who’s strong enough to battle tirelessly on your behalf. You need an advocate with a heart.

We guarantee to always put your future first

You don’t pay for anything until your case is won or settled. We treat you as we would our family, making ourselves available 7 days a week to guide you through these difficult times. We are selective when taking on new clients so that you receive the attention you deserve, and the commitment to win your case.

Campisi is head of the class

At Campisi LLP, you and your family are in good hands. Our Managing Partner is not only an exemplary personal injury lawyer, he is a professor of Insurance Law at York University’s Osgoode Hall Law School. He has been recognized in the 2022 edition of Best Lawyers®  in Canada for Personal Injury Litigation, a highly respected resource for both clients and professionals. Our lawyers have successfully represented thousands of clients with serious injuries like yours, and will use their extensive knowledge of the law, the medicine and the insurance system to win your case.