What are Accident Benefits for a "Cold Case"?

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. 

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.

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.

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.