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Accident Benefits

This section is intended to provide a brief overview of the benefits available to victims of motor vehicle accidents under the Statutory Accident Benefits Schedule, which are often referred to as “accident benefits” or “no-fault benefits”.

The legislation governing accident benefits has undergone numerous changes in the past.  Its current form is O. Reg. 34/10: STATUTORY ACCIDENT BENEFITS SCHEDULE – EFFECTIVE SEPTEMBER 1, 2010 (“the SABS”), which consists of 18 parts.  Below, we discuss some of the most common benefits available to victims of motor vehicle accidents.

Part 2 of the SABS is dedicated to Income Replacement, Non Earner and Caregiver Benefits (also known as “weekly benefits”).  These benefits are paid on a weekly basis if certain criteria are met.  Only one weekly benefit is payable at a given time and in cases where the victim of a motor vehicle accident qualifies for more than one weekly benefit, the victim must elect which benefit to claim.

At Grillo Barristers, we have over 30 years of experience handling accident benefits claims.  We can help you better understand the law and assist you in recovering the compensation that you deserve.  If you or a loved one have sustained injuries from a motor vehicle accident, call Grillo Barristers at 416-614-6000 for a FREE consultation.

Remember, you will not pay any fees until your case is won or settled.

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Learn More About Accident Benefits

Income Replacement Benefits

If you were working at the time of the accident and are unable to return to work as a result of your accident-related injuries, you may qualify for Income Replacement Benefits.  Generally, you will be entitled to Income Replacement Benefits if you are found to suffer a complete inability to perform the tasks of your pre-accident employment.  Should your impairment last more than 104 weeks, however, the test becomes more stringent, requiring a finding that you suffer a complete inability to perform any employment or self-employment for which you are reasonably suited by education, training or experience.

The Caregiver Benefit

The Caregiver Benefit is meant to compensate victims of motor vehicle accidents who are unable to return to a non-paying caregiving role that they held at the time of the motor vehicle accident.  Following legislative changes on September 1st, 2010, the Caregiver Benefit is not available unless it is purchased as an optional benefit or, if the injuries sustained in the motor vehicle accident are deemed to be catastrophic.  The result, unfortunately, is that fewer Ontario policy holders are entitled to this benefit.  If you are, or may become, the primary caregiver to a person in need of care, it is important to know whether you have access to caregiver benefits or not.

Non-Earner benefit

Victims who are unemployed at the time of the accident may qualify for the Non-Earner benefit.  The test for Non-Earner Benefits is one of the most stringent tests in the SABS, requiring the victim to suffer a complete inability to carry on a normal life in order to qualify for this benefit.  This determination requires a detailed analysis of the victim’s pre-accident and post-accident life.

Medical, Rehabilitation and Attendant Care Benefits

Part 3 of the SABS deals with Medical, Rehabilitation and Attendant Care Benefits.  Attendant Care Benefits are only available to victims that suffer injuries outside of the Minor Injury Guideline.

Medical and Rehabilitation benefits

The type of injury that you sustain in a motor vehicle accident will govern your entitlement to Medical and Rehabilitation benefits.  If your injuries fall within the Minor Injury Guideline, you are entitled to a maximum of $3,500.00 in Medical and Rehabilitation Benefits.  If your injuries are outside of the Minor Injury Guideline (but are not catastrophic), you are entitled to a maximum of $50,000 in Medical and Rehabilitation Benefits.  If you suffer catastrophic injuries, you will be entitled to significantly more in Medical and Rehabilitation Benefits.

If you have been involved in a motor vehicle accident while you are student and you are unable to complete your program, you may be entitled to a maximum of $15,000.00 in Lost Educational Expenses under Part 4 of the SABS.

Expenses of Visitors

Also found under Part 4 of the SABS is Expenses of Visitors. This benefit is intended to cover eligible expenses incurred by a visiting parent, grandparent, sister, brother, spouse, child, and/or grandchild, in connection with your treatment for the motor vehicle accident. This benefit will cover all reasonable and necessary incurred expenses with respect to visiting the injured person during his/her treatment or recovery.

Housekeeping and Home Maintenance Expenses

Another Benefit found under Part 4 of the SABS is Housekeeping and Home Maintenance Expenses, which reimburses the accident victim for up to $100/week of housekeeping and home maintenance services.  This benefit is only payable if purchased as an optional benefit, or if you are deemed to have suffered a catastrophic injury.

Death and Funeral Benefits

Part 5 of the SABS deals with Death and Funeral Benefits.  In the unfortunate event of an accident-related fatality, Funeral Benefits will pay up to $6,000 for funeral-related expenses.  Death benefits may also be available to the surviving spouse and/or dependents of the victim. In certain situations, other persons may be able to receive Death Benefits.

Tort vs. AB – What’s the Difference?

When a person is involved in a motor vehicle accident, there are two potential avenues for recovery/compensation.  One avenue is through accident benefits (or “AB”) and the other is by way of a tort claim against the at-fault party or parties.

In Ontario, almost everyone that is involved in a motor vehicle accident will have access to Accident Benefits.  The compensation available through Accident Benefits, as well as the tests that need to be met in order to qualify for benefits, are codified in the Statutory Accident Benefits Schedule (or, the “SABS”).  These benefits are usually obtained through the victim’s own insurance company, however, these benefits are still available to those that do not have an insurance policy of their own.

The purpose of accident benefits is to ensure that victims receive timely access to essential benefits, such as medical/rehabilitation, attendant care, and income replacement. Some benefits are standard and apply to all policies, while others are optional benefits that must be purchased from your insurer before the accident occurs.

When disputes arise over a victim’s entitlement to a benefit, the accident benefits dispute process requires that mediation and arbitration be initiated within the applicable time limits.

A tort claim can be advanced where the victim’s injuries are severe.  In order to advance a successful tort claim, the victim must not be 100% responsible for the accident, and the victim must have commenced an accident benefits claim.  The tort claim is brought against third parties (usually the owner and operator of the third party motor vehicle) and the claim is usually defended by the third party’s insurer. Damages in tort can include pain and suffering, past and future income loss, out of pocket expenses, and other items.

Who can apply for Accident Benefits?

If you were involved in a motor vehicle accident in Ontario, you are entitled to commence a claim for accident benefits pursuant to the Statutory Accident Benefits Schedule.  This holds true in all but very limited circumstances, such as when a victim is involved in a motor vehicle accident while at work (and even in that case, there may still be a viable claim for accident benefits).

By default, accident benefits claims are submitted to the victim’s own automobile insurer.  In cases where the victim does not have their own automobile insurance policy, there are “priority” rules to help determine the appropriate insurer.  Even in cases where the accident benefits application is submitted to the wrong insurer, however, that insurer is obliged to respond to the victim’s accident benefits claim, and then it is the insurer’s responsibility to later seek reimbursement from the appropriate insurer.

In rare circumstances, there may be no insurance company to respond to your accident benefits claim.  This may occur when the victim does not have an automobile insurance policy of their own and the third party is either unidentified or uninsured.  In these types of situations where there is no insurer to respond, the victim’s accident benefits claim may be submitted to the Motor Vehicle Accident Claims Fund (“MVAC”).  MVAC is the payer of last resort, meaning that they will not respond unless there is no other insurer that will respond.  Furthermore, certain criteria must be met before submitting a claim to MVAC.

As you can see, there are various factors to consider when commencing an accident benefits claim.  To preserve your rights and ensure you receive the appropriate compensation, you should contact a lawyer as soon as possible after being involved in a motor vehicle accident.

What to expect

When a benefit is denied by an insurer, formal written notification is provided by the insurer to the claimant. The denial usually comes following an Insurer’s Examination – under Section 44 of the SABS. If the claimant then wishes to challenge the denial of benefit, he/she is subject to section 280 of the Insurance Act which provides that the parties must participate in a mandatory mediation with a mediator from the Financial Services Commission of Ontario (“FSCO”), in an attempt to resolve the dispute. Assuming the mediation is unsuccessful, a Report of Mediator is issued to the parties and then, an application for arbitration is submitted with FSCO Arbitration proceedings, which is subject to the Dispute Resolution Practice Code. The Insurer will typically not engage in Settlement negotiations within the first year of your claim.

Insurer’s Examination

The Insurer may subject a claimant to medical examinations for several reasons and subsequently may deny one or more benefits based on the opinion (s) of medical doctor(s) who assess the injured victims on behalf of the insurance companies.

These assessments are also known as insurer’s examinations. The insurance company has a right to have the car accident victim assessed and provide the insurer with a copy of the results and the decision that follows such an examination. If benefits are denied, a claimant can enter in a Dispute between the claimant and the insurance.

Examination Under Oath

Insurance companies are entitled to examine a claimant under oath. These examinations are done with the present of your legal reprehensive. The examinations are usually done if there are coverage disputes but can also be done so that the insurer can better evaluate a claimant’s injuries and the claim.

An Examination Under Oath could expedite the approval of benefits previously denied by the insurer. However, it could also be detrimental to a claim, if the claimant is not aware of the procedures and lacks knowledge of the law. We highly encourage you to seek legal advice prior to participating in a EUO.


Also known as Alternative Dispute Resolution (ADR), mediation takes place when a disputes arise as a result of a denial from the insurer. It is an informal process where a Mediator is appointed by the government and helps the parties involved resolve the issues in dispute. Many claims settle at this stage. If the Mediation fails the next step is Arbitration.

Pre-Arbitration Hearing

Once an application for Arbitration is submitted, a Pre-Arbitration hearing is scheduled. An Arbitrator is now appointed to guide all the parties to either reach a solution or to set orders for an Arbitration. The Pre-hearing requires all parties to attend with full authority to settle the issues in dispute.  In many instances, the insurer will be looking to use this opportunity to negotiate a full and final settlement of the entire claim.  Although it may be tempting to enter into a full and final settlement at this stage, sometimes the amount of information required is not available or the claim is not ready for settlement. However, a large portion of claims do settle at this stage.


Arbitration is a well-established and widely used means to end disputes. In this stage, an Arbitrator will be appointed and he or she will make the final decision.


As per the legislation, cash settlement discussion can only commence a year after your accident. Your legal representative will help negotiate on your behalf to ensure you receive the maximum amount of benefits you may be entitled to.

Call Grillo Barristers for a FREE consultation.

Remember, you will not pay any fee until your case is won or settled.

Client Testimonials
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Pino R
Pino R
16:53 17 Oct 18
My most recent visit at Grillo Barristers was with Evanee Y. A very polite and professional young lady. She was totally informative, attentive and enlightening. She came across very understanding and caring. Our business encounter was quick and easy. I left very satisfied. Indeed a pleasure, thank you.
Robin Spencer
Robin Spencer
16:41 09 Oct 18
I highly recommend Grillo Barristers especially personal injury lawyer, Rachelle Mitri. Rachelle and her team are professional and very personable. They provide excellent service and support to their clients and ensure that they are comfortable throughout the legal process. Rachelle and her support staff were always available to answer all of my questions and provided updates whenever possible.The outcome of my proceedings were extremely favourable and I recommend Grillo Barristers to anyone in need of personal injury lawyers.
Alex Ba
Alex Ba
14:54 04 Oct 18
My experience with Grillo Barristers began two years prior with a different lawyer than that which ended up following through with my case. I had mixed feelings back then, but with Anthony taking over, everything changed. He was able to instill confidence, assurance, and positivity throughout my experience with Grillo. When I thought that I had no chance with my case, he was able to pull through and deliver much more than I had ever expected. I thank Anthony and Grillo sincerely for all of their efforts, dedication, and hard work on ensuring the best outcomes for me. I would recommend Grillo for anyone seeking legal advice and support.
Bernadette Alcos
Bernadette Alcos
15:22 21 Sep 18
Rachelle was an absolute pleasure to work with. She represented myself and my needs with professionalism and compassion, with the complete understanding of my situation. She kept me informed on the status of my claim and was readily available to answer any questions and/or concerns. She is very diligent and prompt with her responses. Rachelle is an amazing lawyer and I highly recommend her services.
B Gaff
B Gaff
14:40 18 Sep 18
After my wife was in a car accident a little over 2 weeks ago (not her fault), we felt that no one was addressing her actual needs to get better until we walked into Grillo Barristers law firm. The minute we walked in our needs seemed to be their only concern. The receptionist made every effort to make sure we were comfortable while we waited for our appointment. Rinya our Intake Coordinator was pleasant and attentive to my wife's concerns and her needs for recovery. If the rest of the team is that good, we should be in great hands.
courtland holder
courtland holder
14:27 12 Feb 18
My wife & I had the pleasure of working with Alexander Lee and Ikbir Khongura. They were excellent in research and information, They both were on time and ready.. very professional and determined to get the best results for us. They worked very hard and made sure we as clients were comfortable, happy and well taken care of! Most importantly they are fighters, they made sure our best interest were put first and our needs were met. A lot of lawyers don't really care, but they made sure justice was served! They did an amazing job in taking care of us and will be recommending their services!
Jan MacMillan
Jan MacMillan
23:28 05 Feb 18
I worked with Rachelle Mitri and her team and I found the company in general and Rachelle in particular to be extremely professional, while being nice people to work with. Ms. Mitri kept me informed of my case. And guided me through an unfamiliar system with great diligence. I always felt valued and respected. Great Lawyers !
Theresa Dea
Theresa Dea
23:10 19 Dec 17
It's unbelievable how long it takes for the insurance companies to settle. They live by the fact that they can outlast you! Don't give up! Hang in there! Stefanie and her team worked hard and did an excellent job. I received the best settlement available!!!
Luci S.
Luci S.
21:46 08 Dec 17
From the moment Grillo Barristers took on my case, until I was able to come to my desired settlement, they have been nothing but amazing, caring and professional. I had an amazing team working on my case, and couldn't believe how well and timely my file was handled. My lawyer Anthony Andreopoulos, with the tremendous help of Justine and Zachary, constantly kept me updated with every action that was taken on the file and made me feel at ease knowing my case was in good hands. I couldn't have asked for a better firm to handle my file, so thank you guys so much for everything, I appreciate it more than you know!
Patrick k
Patrick k
19:13 07 Dec 17
Where do I begin?? I am not usually one to leave reviews on services but this one is definitely an exception. From start to finish, I felt incredibly comfortable having my claim in Grillo's hands. I felt as though the team was in complete control and I could just sit back and receive updates when necessary. With the utmost confident I can say that Grillo Barristers is the best personal injury law firm in Toronto. The process was quick, cheap and stress free. I must especially thank Lauren Sivitilli. Having very limited knowledge of lawsuits, Lauren was able to perfectly break the processes down for me and educate me on my claim. She was quick to answer emails addressing any concerns and always kept me up to date. I will definitely be recommending Grillo Barristers services to my family, friends and coworkers. Amazing!
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