When you're injured in an accident in Ontario, the Statutory Accident Benefits Schedule (SABS) provides a range of benefits designed to help you recover financially. Two of the most significant — and most misunderstood — are Income Replacement Benefits (IRB) and rehabilitation benefits. Many accident victims either don't claim them at all or accept less than they're entitled to.
What Are Income Replacement Benefits (IRB)?
If you were employed or self-employed at the time of your accident and your injuries prevent you from returning to work, you may be entitled to Income Replacement Benefits. IRB replaces a portion of your pre-accident income on a weekly basis while you're unable to work.
Standard Amount: 70% of your gross weekly income, up to a maximum of $400 per week under the standard benefit level. Optional Higher Limits: If you purchased optional benefits, limits may be $600, $800, or $1,000 per week.
The Two-Stage Test for IRB Eligibility
- First 104 weeks: You must be unable to perform the essential tasks of your own occupation.
- After 104 weeks: You must be unable to perform any occupation for which you are reasonably suited by education, training, or experience.
Non-Earner Benefits: If You Were Not Working
If you were not employed at the time of the accident, you may instead qualify for Non-Earner Benefits (NEB). NEB pays $185 per week if you suffer a complete inability to carry on a normal life as a result of your injuries.
Rehabilitation Benefits Under SABS
Medical & Rehabilitation: Covers treatments, assessments, and services related to your injury. Attendant Care: Covers the cost of personal care assistance if your injuries require help with daily activities.
Under standard SABS limits, medical and rehabilitation benefits are capped at $65,000 for non-catastrophic injuries and $1,000,000 for catastrophic injuries.
What Counts as a 'Catastrophic' Injury?
- Paraplegia or quadriplegia
- Amputation of an arm or leg
- Severe brain injury meeting specific criteria
- Total loss of vision in both eyes
- A combination of impairments resulting in a whole person impairment (WPI) of 55% or more
Common Problems With IRB and Rehab Claims
- Insurers dispute the extent of your injuries and deny or cap benefits early
- Repeated independent medical examinations (IMEs) to challenge your claim
- IRB reduced based on income from other sources (CPP, EI, etc.)
- Rehabilitation expenses denied as "not reasonable and necessary"
- Benefits cut off at the 104-week transition without proper reassessment
If you and your insurer disagree about entitlement to statutory accident benefits or the amount payable, you may be able to apply to LAT-AABS, subject to applicable rules and deadlines. Official source: https://tribunalsontario.ca/lat-aabs/