If you are hurt in a car accident in Ontario, you have a claim against your own insurance company no matter who caused the crash. That claim is for statutory accident benefits, and it is governed by a regulation called the Statutory Accident Benefits Schedule, O. Reg. 34/10. This page explains what it covers, what it pays, and the deadlines that will catch you out if nobody tells you about them.
It also explains what changed on 1 July 2026, because the answer to the most basic question, what am I entitled to, is no longer the same for everybody.
Accident benefits and the claim against the driver are two different things
People often think they have one claim. They usually have two, and they run on separate tracks with separate deadlines.
- The accident benefits claim is against your own insurer. It pays for treatment and, depending on your policy, replaces income. Fault does not matter. This is the claim this page is about.
- The claim against the person who caused the collision is a lawsuit. It covers pain and suffering, income loss beyond what accident benefits pay, and other losses. Fault matters a great deal, and the limitation period is different.
Both can run at the same time, and what happens in one affects the other. Our car accident page deals with the lawsuit side.
What is mandatory and what is optional
This is the part that changed. On 1 July 2026 most of the Schedule became optional coverage that has to be purchased, under O. Reg. 383/24.
- Still mandatory on every policy: medical, rehabilitation and attendant care benefits, which are Part III of the Schedule.
- Now optional: income replacement, non‑earner and caregiver benefits (Part II), housekeeping and other expenses (Part IV), death and funeral benefits (Part V), and the additional optional benefits (Part VI).
If your policy renewed on or after 1 July 2026, the benefits you already had carry over at the same amounts unless you and your insurer agreed in writing to decline or change them. Our page on the 1 July 2026 changes sets out exactly how that works and who the optional benefits now reach.
Medical, rehabilitation and attendant care
This is the mandatory core, and how much is available turns entirely on which of three categories your injuries fall into.
1. Minor injury, $3,500
Where your impairment is predominantly a minor injury, medical and rehabilitation benefits are capped at $3,500 plus HST, under section 18(1). A minor injury means a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation, and any clinically associated sequelae.
This is the single most contested decision in the whole system, and it is often wrong. Our Minor Injury Guideline page explains the category and the ways out of it.
2. Non-catastrophic, $65,000
If you are not held to the minor injury limit, medical, rehabilitation and attendant care share a single combined limit of $65,000 plus HST, under section 18(3)(a). Attendant care within that is capped at $3,000 per month, under section 19(2).
3. Catastrophic impairment, $1,000,000
Where the impairment is catastrophic as defined in section 3.1, the combined limit is $1,000,000 plus HST, under section 18(3)(b), and attendant care rises to $6,000 per month. Getting an impairment recognised as catastrophic is a formal process with its own medical criteria, and it changes the economics of a claim completely.
If you bought extra coverage
Optional benefits raise all of this, under section 28(1):
- An optional benefit takes the non‑catastrophic combined limit from $65,000 to $130,000
- A further option takes it to $1,000,000, and removes the time limit on when expenses have to be incurred
- For a catastrophic impairment, the optional coverage takes the combined limit to $2,000,000
The time limit people miss
For someone 18 or older at the time of the accident, no medical, rehabilitation or attendant care expense is payable if it is incurred more than 260 weeks, five years, after the accident. For someone under 18, the limit runs to their 28th birthday. Neither applies to a catastrophic impairment. That is section 20.
The benefits that are now optional
These are the benefits that depend on what your policy includes. Where one was purchased, the amount is whatever the policy endorsement fixed, because the Schedule no longer states a figure for any of them.
- Income replacement. 70 per cent of gross weekly income, less other income replacement assistance, up to the amount your policy fixed. The flat $400 a week maximum that applied for years is no longer in the regulation. After 104 weeks the test gets harder, and insurers often end the benefit by naming other jobs you could supposedly do: see whether the alternative job has to pay comparably.
- Non‑earner benefit. For someone who suffers a complete inability to carry on a normal life and does not qualify for income replacement, often a student.
- Caregiver benefit. For someone who was the main caregiver for a person in need of care and can no longer do it.
- Housekeeping and home maintenance. The reasonable additional cost of work around the house you can no longer do.
- Lost educational expenses, visitor expenses, and the cost of repairing or replacing clothing, glasses and hearing aids damaged in the accident.
- Death and funeral benefits.
- Optional dependant care and indexation benefits.
You cannot look up what these pay. You have to read the policy. Send it to us and we will tell you what you have.
How to apply, and the deadlines that matter
Alert: telling your insurer about the crash is not a claim for accident benefits. In Jakupovic v. Intact Insurance Company, 2026 ONCA 651, the Court of Appeal held that reporting an accident, even repeatedly, does not satisfy the seven day notice requirement in section 32(1). You have to say that you intend to claim benefits. If you are already late, section 34 can still excuse the delay where you have a reasonable explanation, but the explanation will be tested. Read what the decision means for your claim.
Three dates decide most of this, and two of them are short.
- Seven days to notify. You must tell the insurer you intend to apply no later than the seventh day after the circumstances giving rise to the benefit arose, or as soon as practicable after that. Section 32(1). Missing it is not automatically fatal, but do not test it.
- Thirty days to apply. Once the insurer sends you the application forms, you have 30 days to return a completed and signed application. Section 32(5).
- Two years to dispute. An application to the Licence Appeal Tribunal must be commenced within two years after the insurer refuses to pay the amount claimed. Section 56. This one is hard, and it runs from the refusal, not from the accident.
The claim runs on standard forms, the OCF series. The application itself is the OCF‑1. Treatment is requested on a treatment and assessment plan, the OCF‑18, except inside the Minor Injury Guideline where it is confirmed on an OCF‑23. Not everything needs a plan: prescribed drugs and goods costing $250 or less per item do not, under section 38(2).
If the insurer says no
A denial is a decision by one party to the contract, not a finding of fact. Disputes go to the Licence Appeal Tribunal, and the two year clock in section 56 starts with the refusal.
There are also circumstances where benefits are genuinely not payable, set out in section 31. They include driving while knowing the vehicle was uninsured, driving without a valid licence, being an excluded driver, driving without the owner’s consent, and material misrepresentation. Those are specific and they have to be proved.
What we see most often is not an exclusion. It is a minor injury designation, a benefit stopped on the strength of an insurer’s assessment, or a benefit refused because it was supposedly never purchased. Each of those is checked a different way, and the last one is checked against the policy.
Send us your policy
Since 1 July 2026 the honest answer to most entitlement questions begins with reading the policy and the endorsement. Nobody can tell you what your income replacement benefit pays without seeing what you bought. We will read it and tell you plainly what is covered, what is not, and what the insurer has got wrong.
Exceptions may apply ‑ legal advice is strongly recommended for your particular situation.
Speak to a lawyer about an accident benefits claim
Initial consultations are free. Our fee schedule is published in full, by stage of the case, on our Fair Fees page. Call 905-409-2438, send a text, message us on WhatsApp, or use the contact form.
Steven Polak is licensed as a lawyer in Ontario and practises with Lerners LLP at 123 Athol Street, Whitby.
This page describes O. Reg. 34/10 as amended to 1 July 2026. Last reviewed 3 November 2026.