Accident Benefits and Insurer Denials in Ontario

Who this helps

Anyone injured in a car accident in Ontario, including drivers, passengers, pedestrians, cyclists and rideshare riders, who needs to apply for accident benefits or whose benefits have been reduced or denied.

What accident benefits are

Accident benefits are no-fault insurance benefits under the Statutory Accident Benefits Schedule. You can claim them whether or not you caused the collision. Depending on your policy and injuries, they can include medical and rehabilitation benefits, attendant care, and income-related and other benefits. Recent changes to Ontario auto insurance have made some benefits optional, so what is available depends on the coverage on the policy that responds to your claim.

Strict early deadlines

• Notify the insurer within 7 days of the accident, or as soon as practicable.
• Submit the application for accident benefits within 30 days after receiving the forms from the insurer.
• Disputes go to the Licence Appeal Tribunal, generally within two years of the insurer's denial.

Late notice does not always end a claim, but it can create problems that are avoidable.

Which insurer pays

You usually claim through your own auto policy, or a policy on which you are listed or a dependant. If you have no coverage, priority rules decide which insurer responds, which may be the insurer of the vehicle that hit you. As a last resort, the Motor Vehicle Accident Claims Fund may respond. We identify the right insurer early to avoid delay.

When the insurer says no

Insurers often deny or cut off benefits after an insurer's examination, by placing injuries within the Minor Injury Guideline, or by disputing income loss. A denial must give reasons. We review the file, gather medical evidence from your treating providers, and bring an application to the Licence Appeal Tribunal where needed. Many disputes resolve at a case conference before a hearing.

Accident benefits and a lawsuit

Accident benefits are separate from a claim against the at-fault driver for pain and suffering and other losses. Both can proceed at the same time. See car accident claims for how the two fit together.

Documents to bring

• Your auto policy and claim number
• Any letters, explanation of benefits or denials from the insurer
• Treatment plans (OCF-18) and receipts
• Proof of income and time missed from work
• Medical records and your doctor's contact information

Fees

Injury consultations are free. Most files are handled on a contingency fee under a written agreement. Read how injury fees, costs and disbursements work.

Catastrophic impairment

If an injury is severe, ask whether it may meet the catastrophic impairment criteria, which can significantly increase available benefits. See also brain injury and spinal cord injury claims.

July 2026 changes to accident benefits

For policies issued or renewed since July 1, 2026, only medical, rehabilitation and attendant care benefits are mandatory. Income replacement and other benefits are optional and only cover the policyholder, their spouse, dependants and listed drivers. Your auto insurer now pays medical and rehabilitation expenses first, except medication. Read what changed in July 2026 and accident benefits if you don't have car insurance.