Statutory Accident (SABS) Benefits – Making Sense of it All

If you have been involved in a motor vehicle accident and suffered personal injuries, you can make a claim for statutory accident benefits.

Statutory Accident Benefits (SABS benefits) – What are they?

Statutory Accident Benefits benefits are also known as “no-fault” benefits because they are available to people regardless of whether they are responsible for causing the collision. The types of benefits available to a person involved in a car accident include benefits that provide funding for support around the home, treatment, assistive devices, home modifications, and income loss.

A person’s entitlement to benefits is set out in the Statutory Accident Benefits Schedule. The Statutory Accident Benefits Schedule addresses the following:

1. the types of benefits available to the injured person;
2. the amount of benefits and duration of coverage available to the injured person;
3. how to apply for benefits;
4. the criteria to qualify for benefits;
5. the insurance company’s obligations;
6. the injured person’s obligations; and
7. deadlines for the injured person and the insurer.

A claim for SABS benefits is separate from a lawsuit. It does not replace or prevent you from bringing a lawsuit.

The Types of SABS Benefits Available to Injured Persons

There are many different types of SABS benefits available to persons injured in motor vehicle accidents. They include:

• Income replacement benefits;
• Non-earner benefits;
• Caregiving benefits;
• Attendant care benefits;
• Medical and rehabilitation benefits;
• Housekeeping and home maintenance benefits;
• Death benefits;
• Funeral benefits; and
• Payment of other expenses including lost educational expenses, visitor expenses, and expenses relating to damaged clothing and other personal items such as glasses and hearing aids.

How to Apply for SABS Benefits

To apply for SABS benefits the injured person must complete and submit the following forms:

OCF-1: The Application for Accident Benefits

This form is completed by the injured person or their representative.

OCF-2: Employer’s Confirmation

This form is completed by any employer that employed the injured person in the 52-week period before the accident. If the injured person is self-employed, they complete their own form.

OCF-3: Disability Certificate

This form is completed by a health practitioner (chiropractor, dentist, nurse practitioner, occupational therapist, optometrist, physician, physiotherapist, psychologist, or speech-language pathologist).

It is important that these forms be completed properly and on time. The insurance company will rely on these forms when deciding which benefits to pay. Incomplete or incorrect information could negatively impact an injured person’s claim for SABS benefits.

These forms, and others that are commonly used in a SABS benefits claim, can be provided by the insurance company, although it is generally easier (and faster) to download them from Financial Services Commission of Ontario website: https://www.fsco.gov.on.ca/en/auto/forms/pages/ocf_forms.aspx.

How much coverage is available for treatment?

The amount of SABS benefits available to an injured person for treatment will depend on several factors, including:

• The classification of motor vehicle accident-related injuries; and
• Whether the injured person had optional coverage (for additional benefits) at the time of the motor vehicle accident.

Injury Classification

The type and amount of SABS benefits coverage a person injured in a motor vehicle accident is entitlement to will depend on the classification of their injuries. There are three categories of injuries:

1. Minor Injury,
2. Non-Catastrophic Injury, and
3. Catastrophic Injury.

The classification of the injury will determine the amount and duration of medical, rehabilitation and attendant care benefits available to the injured person.

The classification of injuries also impacts other SABS benefits like the housekeeping and home maintenance benefit or the non-earner benefit, which are only available to injured persons with catastrophic injuries.

An improper classification of an injured person’s injuries will have a significant impact on how much funding is available to the injured person. This can result in increased financial stress and limited funding for treatment, which can hinder the injured person’s recovery. Knowing how to prove that injuries fall into the correct classification is key to ensuring the injured person receives the help they need.

Optional Benefits

Automobile insurance companies offer optional benefits which can be purchased from the insurance company an additional cost. Optional benefits can provide additional funding to people injured in motor vehicle accidents for support around the home, treatment, and income loss support.

It is very important that a personal injury and SABS benefits lawyer reviews the details of the automobile insurance coverage their client had in place at the time of the motor vehicle collision.

Amount of Treatment Coverage versus Approved Treatment

Regardless of the amount and duration of SABS benefits coverage that is available to an injured person, the insurance company will only pay for treatment that it concludes is reasonable and necessary. Similarly, the insurance company will only pay for attendant care expenses that it considers reasonable and necessary. Sometimes the insurance company will arrange for the injured person to be assessed by an expert that it chooses in order to help the insurance company decide whether to approve or deny the treatment sought by the injured person. The insurance company will only pay for treatment that it approves.

Time Limits

There are numerous time limits and deadlines set out in the Statutory Accident Benefits Schedule that an accident benefits claimant should be aware of. Here are a few examples:

1. An insured person that intends to make a claim for SABS benefits shall notify the insurance company of the motor vehicle collision within seven days of the collision.
2. A completed application must be submitted to the insurance company within 30 days of receiving the application forms.
3. Insured persons are required to respond to requests from the insurance company for information and/or records within ten days.
4. The insurer has ten days to respond to an OCF-18: Treatment and Assessment Plan. The OCF-18 is completed by a health care practitioner. It sets out the treatment or assessment that is being recommended for the claimant and the funding needed from the insurer for the treatment or assessment.
5. An insurer shall pay any invoices for services it has agreed to pay within 30 days of receiving the invoice.
6. If the insurance company denies a benefit, an insured person has two years from the date of the denial to file a dispute with the Licence Appeals Tribunal.

Failing to comply with a deadline can affect an insured person’s claim for benefits. As personal injury and accident benefits lawyers, we carefully monitor the deadlines set out in the Statutory Accident Benefits Schedule to make sure our clients and their insurer have complied with their respective obligations under the law.

You’ve Been Injured in a Motor Vehicle Accident – What Should You Do?

Contacting a personal injury and SABS benefits lawyer right away will help you:

1. Meet your reporting obligations under the Statutory Accident Benefits Schedule.

2. Properly prepare and submit your application for SABS benefits to the correct insurance company on time.

3. Properly prepare and submit the necessary information and documentation to the insurance company to ensure timely payment of SABS benefits, including income replacement benefits.

4. Assist you in assembling a qualified and experienced treatment team to support you in your recovery.

5. Work to maximize the SABS benefits you are entitled to.

At Beyond Law, our personal injury lawyers are experienced in handling serious motor vehicle accident cases and SABS benefits cases in Toronto and throughout Ontario. If you or a loved one has been involved in a motor vehicle accident, please contact us so we can discuss the types of SABS benefits and compensation that you may be entitled to.