No-fault accident benefits in Ontario generally come from the applicable auto insurer regardless of who caused the accident. They fund specified needs such as medical and rehabilitation treatment, while a separate tort claim may address other losses. This guide explains how the two systems fit together after the July 2026 changes.
Key takeaways: Accident benefits are distinct from a tort claim; medical, rehabilitation and attendant care remain mandatory; other benefits depend on the applicable policy after July 2026.
What “no-fault” means
“No-fault” does not mean that no one is at fault. It means that accident benefits are paid by your own insurer regardless of who caused the accident. The rules for these benefits are set out in the Statutory Accident Benefits Schedule (SABS), Ontario Regulation 34/10.
The idea is to give injured people access to treatment and support quickly, without waiting for fault to be decided. A driver who caused the accident and a driver who was hit while stopped at a red light can both apply for accident benefits from their own insurers.
Which accident benefits are available after July 1, 2026
Since July 1, 2026, standard Ontario auto policies must include only three types of accident benefits:
• medical benefits;
• rehabilitation benefits; and
• attendant care benefits.
Other benefits, including income replacement, non-earner, caregiver, housekeeping and home maintenance, and death and funeral benefits, became optional. Whether you have them depends on the coverage on your policy. When policies renewed after the change, insurers generally continued the prior coverage unless the policyholder declined it in writing. Checking your policy documents, or asking your broker or insurer, is the best way to know what you have.
Older articles and policies may refer to pre-July 2026 standard limits. For policies entered into or renewed on or after July 1, 2026, income replacement, non-earner, caregiver, other-expense, death and funeral benefits are optional under O. Reg. 34/10, s. 2(1.0.1). Current limits depend on the policy and coverage purchased: https://www.ontario.ca/laws/regulation/100034.
Who pays first: auto insurance or your health plan?
Before July 2026, workplace and private health plans generally had to pay first for many medical and rehabilitation expenses, with the auto insurer covering the balance. Since July 1, 2026, auto insurance generally pays first for medical and rehabilitation expenses, other than medication, ahead of workplace or private plans. This change is reflected in a new priority-of-payment endorsement (OPCF 47R). For accidents before that date, the older rules may still apply.
The separate claim against the at-fault driver
Accident benefits are only part of the picture. If another driver caused or contributed to the accident, you may also have a claim against that driver, often called a tort claim or lawsuit. The at-fault driver’s insurer usually defends this claim.
A tort claim can seek compensation for losses that accident benefits do not fully cover, including pain and suffering, past and future income loss, and future care costs. These claims are subject to special rules:
• Threshold: to recover damages for pain and suffering, the injured person generally must show a permanent serious impairment of an important bodily function, or serious permanent disfigurement (Insurance Act s.267.5).
• Deductible: for 2026, the non-pecuniary deductible is $47,913.01 unless damages exceed $159,708.71. See O. Reg. 461/96, s. 5.1(1), Insurance Act, s. 267.5(8.3), and FSRA’s guidance: https://www.fsrao.ca/industry/auto-insurance/regulatory-framework/guidance-auto-insurance/2026-automobile-insurance-indexation-amounts-guidance.
How the two claims interact
Because Ontario law aims to prevent double recovery, accident benefits you received, or were entitled to receive, may be deducted from damages awarded in the tort claim for the same type of loss. Other payments, such as disability benefits, can also affect what is recoverable. This is one reason it is important to coordinate the two claims carefully.
Getting information about the other driver
Many people expect the police report to tell them who the other driver and insurer are. Copies of police reports provided to the public may be redacted, sometimes removing details about the other driver. Your own insurer, or a lawyer, may be able to obtain the information needed to identify the at-fault party and their insurer.
First steps
• Notify your own insurer promptly and ask for an accident benefits application package.
• Complete the OCF-1 Application for Accident Benefits carefully.
• Check your policy for optional benefits you may have purchased.
• Keep records of all treatment, expenses and time off work.
• Get advice about the tort claim and its time limits.
Conclusion
No-fault accident benefits in Ontario and a tort claim serve different purposes. Contact Booni Law at admin@boonilaw.com or +1 (226) 271-1751 to discuss the applicable policies. No outcome is promised.
Frequently Asked Questions
Why is my insurer paying if I was not at fault?
Ontario’s accident benefits system is “no-fault”: your own insurer pays benefits regardless of fault. A separate claim may be made against the at-fault driver.
Will my premiums go up if I claim accident benefits?
Premium decisions depend on the insurer and on how fault is determined under Ontario’s fault determination rules. Ask your insurer or broker.
Do I still have income replacement benefits after July 2026?
Only if your policy includes them. Income replacement became optional on July 1, 2026. Check your policy.
Can I sue the at-fault driver as well?
Yes, potentially. A tort claim is separate from accident benefits, but it is subject to a threshold, a deductible and time limits.
Does my workplace health plan pay first?
Since July 1, 2026, auto insurance generally pays first for medical and rehabilitation expenses other than medication. Older accidents may follow earlier rules.
Questions about accident benefits or a claim against the other driver?
If you were injured in a car accident, Booni Law can explain how your accident benefits and any claim against the at-fault driver may work together. Email Booni Law at admin@boonilaw.com or call +1 (226) 271-1751. Every case depends on its own facts and policies.
Disclaimer: This article is provided for general informational purposes only and does not constitute legal advice. Reading this article does not create a solicitor-client relationship between you and Booni Law. The information in this article may not reflect the most current legal developments and should not be relied upon as a substitute for professional legal advice tailored to your specific circumstances. If you require legal advice, please contact Booni Law.
