When you’ve been injured in a car accident, whether as a driver, cyclist, passenger, or pedestrian, one of the most important legal tools available to support your recovery is Ontario’s accident benefits system.
In Episode 7 of Civil Banter, our hosts Hamish and Stan continue their exploration of this system, focusing on what happens after the initial trauma of an accident, including how medical, rehabilitation, and care benefits work, and who qualifies for what.
Understanding Medical and Rehabilitation Benefits
Unlike income replacement or non-earner benefits, medical and rehabilitation benefits don’t come to you in the form of a cheque. Instead, your treatment providers (like physiotherapists or psychologists) submit plans to your insurance company, who then approve (or deny) the funding.
To qualify, the treatment must be:
- Reasonable and necessary
- Directly related to injuries sustained in the accident
These benefits are subject to funding caps, which vary depending on the severity of your injury.
The Three Tiers of Treatment Coverage
Ontario’s accident benefits system sorts injuries into three categories, each with its own level of coverage:
1. Minor Injury Guideline (MIG) – Up to $3,500
This is the default level of funding for common, lower-severity injuries like:
- Sprains and strains
- Whiplash
- Contusions or bruises
- Cuts or abrasions
If your injury falls under this definition, you’ll be limited to $3,500 in treatment coverage—unless you meet certain criteria to “exit” the guideline.
2. Non-Minor Injury Coverage – Up to $65,000
Injuries that fall outside the MIG—such as broken bones, concussions, or psychological trauma—can access a significantly higher level of funding, with a five-year time limit to claim.
This broader coverage allows for treatment like:
- Physiotherapy
- Chiropractic care
- Massage therapy
- Psychological counselling
- Occupational therapy
You may also qualify for this level if you have a pre-existing condition that makes recovery more difficult (e.g., a previous injury, chronic pain, or mental health vulnerabilities).
3. Catastrophic Impairment Coverage – Up to $1 million (lifetime)
For those with severe, long-term injuries, catastrophic designation unlocks up to $1 million in lifetime benefits. This covers not just medical and rehabilitation care, but also additional supports like attendant care and housekeeping assistance.
Catastrophic cases may involve:
- Serious brain injuries
- Spinal cord damage
- Multiple fractures
- Permanent physical or cognitive impairments
What Is Attendant Care?
Attendant care benefits are separate from treatment and are meant to cover the cost of having someone help you with daily living, such as dressing, meal prep, mobility, and personal hygiene.
An occupational therapist typically assesses your needs and recommends how many hours of care are required per week. While this benefit is often associated with catastrophic injuries, it can also be available in other cases depending on the level of need.
More Than Just Medical
Hamish and Stanford also highlight several lesser-known accident benefits available under Ontario’s system, including:
- Housekeeping and home maintenance assistance (available only to those with catastrophic injuries)
- Lost educational expenses for students who have to withdraw from school
- Repair or replacement of damaged clothing or personal items (e.g., helmets or medical devices)
- Funeral and death benefits in the case of fatal accidents
Putting the “Auto” in “You Auto Know”
This episode also introduces a new segment, You Auto Know, where Stan quizzes Hamish on real-world cases involving accident benefits eligibility.
The debut case? A cyclist who fell on a slippery patch of what appeared to be oil—left behind by an unknown vehicle. The tribunal ultimately found that the accident was caused by the use and operation of a motor vehicle, even though no vehicle was seen at the scene.
It’s a great example of how Ontario’s accident benefits regime is meant to cast a wide safety net, ensuring that injured people aren’t left without support due to technicalities.
Looking Ahead: Changes Coming in 2026
Finally, the hosts touch on upcoming changes to Ontario’s auto insurance system. Starting in July 2026, certain accident benefits such as income replacement will become optional add-ons. This means drivers will need to actively choose the coverage they want, rather than receiving it automatically.
While more choice may benefit some (e.g., retirees who don’t need wage replacement), it may also leave people underinsured if they don’t fully understand what they’re opting out of.
The takeaway? Read your policy carefully, and consider speaking to an insurance broker to ensure your coverage meets your needs.
Final Thoughts
Ontario’s accident benefits system is complex, but it’s also one of the most important sources of support for people injured in motor vehicle accidents. Whether your injuries are minor or life-changing, there are legal mechanisms in place to help you access the care and resources you need.
