Statutory Accident Benefits Services (SABS)

Question: What statutory accident benefits are available to Ontario automobile accident victims, and how do I claim the right coverage?

Answer: In Ontario, automobile accident victims may be entitled to compulsory Statutory Accident Benefits under the SABS (O. Reg. 34/10) for losses and injury-related expenses no matter whether you were a driver, passenger, pedestrian, or cyclist; coverage is structured through income replacement and other categories (like medical expenses, housekeeping, and potentially catastrophic impairment) and is determined by the priority of payment so you generally claim SABS from your own insurer (the insurer covering you), not necessarily the insurer of the at-fault driver.  If you need help verifying eligibility, meeting notice and documentation requirements, and pushing your claim for the benefits you deserve without delays or reduction tactics, PKM Legal Services can help with paralegal-supported SABS claims and advocacy in Ontario; call (519) 410-5250.

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What Is the Protection Available For Automobile Accident Victims?

Automobile Insurance Policies In Ontario Provide a Schedule of Statutory Benefits As Coverage to Protect Accident Victims.

Note: Please contact PKM Legal Services by phone at: (519) 410-5250 to discuss any specific questions that you may have.

Understanding the Statutory Accident Benefits Schedule Protection Available to Automobile Accident Victims

In Ontario, injuries arising from an automobile incident, whether the injured person was a vehicle occupant, pedestrian, or cyclist, the Insurance Act, R.S.O. 1990, c. I.8, prescribes certain accident benefits protection.  The accident benefits coverage within an automobile insurance policy, commonly referred to as SABS, being an acronym for the Statutory Accident Benefits Schedule, O. Reg. 34/10 ("SABS"), are a compulsory requirement for every automobile, motorcycle, snowmobile, among other things, operating on roadways and other than purely private lands, provides protection for the losses and expenses arising from injuries.

Accident Benefits Coverage
Includes:

Negotiating for the full SABS as are deserved from an insurance company, and handling the claims adjuster who is appointed to protect the interests of the insurance company, requires an intermediary with a strong working knowledge of the statutory coverage provided under the Ontario law as well as advocacy and administrative skills including an understanding of various medical conditions, rehabilitation processes, and abbreviations as the many standard terms used upon insurance sector and health care sector documents.  Additionally, whereas the SABS may be standardized, individual with injuries as the victims of automobile accidents are unique rather than standard and thus much more than a cookie-cutter approach is required so to ensure against any nickel-and-diming that insurance companies are often accused of.  A professional legal representative on the side of an injured accident victim helps to ensure that an insurance company is pushed to provide proper coverage promptly without undue delay.

Qualifying for Coverage

Generally, all persons injured in an incident involving an Ontario registered and insured automobile are entitled to SABS coverage; however, a common misperception is that a person must claim the SABS coverage from the vehicle involved within the incident.  This is untrue.  Under the Ontario no-fault regime, the SABS coverage is provided in accordance to a priority schedule.  Per the priority schedule, an injured person is first required to make claim for SABS coverage from the insurer providing an insurance policy to that person - this is required regardless of the vehicle the person was injured in, or by.  For example, if Bob is insured by ABC Insurance Company and is traveling in an automobile owned by Joe, that is insured by XYZ Insurance company, and becomes injured within an accident involving the automobile owned by Joe, the insurer that Bob must seek SABS coverage from is ABC Insurance Company, being the insurer of Bob, rather than from XYZ Insurance Company as the insurer of Joe.  This priority requiring that a person claim from their own insurance is the requirement regardless of whether Joe caused the accident that injured Bob or whether the accident was caused by some other driver involving some other vehicle.  Again, this priority is counter-intuitive to most people who will, wrongfully, presume that the SABS coverage comes from the insurer of the vehicle responsible for causing the incident.

Priority of Payment

With the above said, there are incidents that involve persons who are without automobile insurance, such as those persons who are simply without insurance because the person is in an automobile.  In these situations, the SABS coverage remains available per the priority of payment schedule, essentially a pecking order, which requires that the person make claim in accordance to the requirements prescribed in section 268(2) of the Insurance Act as follows:

Alternatively, the opposite situation could arise where an injured person has recourse against multiple insurers with which the injured person is an insured.  This could occur, and where this situation exists usually does occur, where a person carries multiple insurance policies with multiple insurers; such as, for example, when Bob (from our example above) carries live coverage with XYZ Insurance Company and ABC Insurance Company but is injured while an occupant of a third party vehicle.  In this situation, per section 268(4) of the Insurance Act, Bob is entitled to make a choice of which insurer to claim from, XYZ or ABC.

The coverage available under the SABS section of an automobile policy is prescribed by the Insurance Act which contains certain statutory limits and conditions, with optional limits available (review with your insurance provider), and which includes protection against, among other things, losses of income (time off work), medical expense, rehabilitation expenses, pharmaceutical expenses.