After an automobile accident, statutory accident benefits can help address treatment, rehabilitation and other losses depending on the coverage available. Lexera helps injured people understand their policy, submit claims and respond to insurer decisions.
Accident benefits are part of Ontario automobile insurance and may be available regardless of who caused the accident. They operate separately from any claim against an at-fault driver.
The benefits available depend on the date of the policy, the coverage purchased and the nature of the injury. Significant changes to Ontario accident benefits took effect on July 1, 2026.
For policies entered into on or after July 1, 2026, medical, rehabilitation and attendant care remain mandatory, while other accident benefits are generally optional.
The nature of the injury, recommended treatment and level of assistance needed can affect the medical, rehabilitation and attendant care benefits available.
Income replacement, non-earner, caregiver and several other benefits may depend on whether that optional coverage applies under the policy.
The correct insurer is not always obvious, particularly for passengers, pedestrians or cyclists. Ontario’s priority rules determine where the application should be made.
Medical, rehabilitation and attendant care remain mandatory. Other accident benefits became optional, making the specific policy and coverage elections especially important when assessing entitlement.
An applicant should generally advise the insurer within seven days of the accident, or as soon afterward as reasonably possible if that deadline cannot be met.
The insurer provides an OCF-1 Application for Accident Benefits. It generally must be returned within 30 days after it is received.
Disability certificates, treatment plans and other medical forms may be required depending on the benefits being claimed and the treatment being requested.
Confirm which mandatory, optional or increased benefits were in place so the claim is assessed against the coverage actually available at the time.
For policies entered into on or after July 1, 2026, these benefits remain part of standard Ontario automobile insurance, with applicable limits and eligibility requirements.
Income replacement, non-earner, caregiver, housekeeping and several other accident benefits are optional under the post-July 2026 framework.
Treatment plans, medical records, disability certificates and attendant care assessments can help establish what care is required and whether the requested benefits meet the applicable criteria.
Employment records, income information and evidence of functional limitations may also be important where optional income, caregiving or other benefits form part of the claim.
Lexera can review the available policy coverage, identify the benefits that may apply and help organize the medical, employment and functional evidence required to support the claim.
The legal team can also respond to insurer denials, treatment disputes and benefit terminations and, where appropriate, address accident benefits disputes before the Licence Appeal Tribunal.
Yes. Statutory accident benefits may be available regardless of who caused the automobile accident, subject to the policy, eligibility rules and benefit-specific requirements.
For policies entered into on or after July 1, 2026, medical, rehabilitation and attendant care benefits remain mandatory. Other accident benefits are generally optional.
The insurer must provide written reasons for a denial. Disputes about entitlement to or the amount of statutory accident benefits can be brought to the Licence Appeal Tribunal.
Generally, an application to the Licence Appeal Tribunal must be filed within two years after the insurer denies the benefit in writing. The circumstances should be reviewed carefully before relying on a deadline.
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