Insurance & Funding for Therapy in Ontario

Ontario operates a no-fault accident benefits system. That does not mean nobody is at fault, it means your own insurer pays for your treatment whether the collision was your fault or not.

Benefits are available to drivers, passengers, pedestrians and cyclists. If you were injured in a collision involving a vehicle, you almost certainly have access to treatment funding.

You do not need a lawyer to claim accident benefits, so nothing has to wait. That said, most people find the process considerably easier with one. A personal injury lawyer will deal with the insurer on your behalf, check that your forms are completed properly before they are submitted, and challenge decisions that go against you. Initial consultations are normally free, and most work on a contingency basis, meaning there is nothing to pay up front.

You must notify your insurer within seven days of the collision, or as soon as practicable. They will send you an application package, usually including the OCF-1 Application for Determination of Catastrophic Impairment and related forms.

If you have missed that window, contact us anyway. Late applications are frequently accepted, and it is better to start now than to assume the opportunity has gone.

Before treatment can be funded, a treatment plan is submitted to your insurer on a form called the OCF-18. It sets out what treatment is proposed, why it is reasonable and necessary, and what it will cost.

We complete that form, submit it to your insurer, and follow it up, so the whole of it is handled for you.

Your insurer then has ten business days to approve, deny, or request an examination. That deadline is set by the legislation and is outside our control.

Where an insurer fails to respond within ten business days, the treatment is generally deemed approved and payable. That is a protection built into the system.

We track those deadlines on your behalf, because a plan sitting unanswered is one of the most common reasons treatment stalls.

Denials happen, often on the basis of an insurer examination that reaches a different conclusion from your treating clinicians.

Where treatment is denied, we prepare the written response challenging that decision and provide the clinical record behind it. You are not left to argue it alone.

If you already have a lawyer, we notify them of the denial as soon as it arrives so they are not finding out about it later, and we work alongside them to challenge it. If you do not, you may choose to instruct one, and a denial can be disputed at the Licence Appeal Tribunal.

Waiting ten business days when you cannot sleep, cannot work and cannot stop reliving the crash is a long time.

Because of that, on a case-by-case basis we may begin treatment before funding is confirmed. This is a decision we make deliberately and individually rather than a blanket policy, so please ask.

This is what funds your counselling, physiotherapy, dietitian services, assessments and equipment.

The amount available depends on classification. Injuries held within the Minor Injury Guideline are limited to $3,500. Injuries outside that guideline are currently covered up to $65,000, and a catastrophic impairment determination raises that limit to up to $1,000,000.00.

The MIG is a framework intended for genuinely minor soft tissue injury, capped at $3,500 in medical and rehabilitation benefits. That figure does not go far.

Many people are placed in the MIG initially and should not be there, particularly where there is a psychological injury, chronic pain, or a pre-existing condition that the collision has made worse.

Proper assessment is what establishes that your injuries fall outside the MIG. An early assessment by a Registered Social Worker or psychotherapist is often the document that achieves it, and where a formal diagnosis is needed, that can come from a psychologist, physician or nurse practitioner.

If you were employed and cannot work because of the collision, income replacement provides 70% of your gross weekly income up to a policy limit.

Since 1 July 2026 this is an optional coverage rather than an automatic one. Policies in force before that date keep it on renewal unless the policyholder actively opts out, so most people are still covered, but newer policies may not include it. Check your declarations page or ask your broker.

For the first 104 weeks the test is whether you suffer a substantial inability to perform the essential tasks of your job. After 104 weeks the test becomes considerably harder: whether you are completely unable to engage in any employment for which you are reasonably suited by education, training and experience.

That change catches many people out. Our vocational and disability assessments speak directly to it.

If you were not employed at the time of the collision, for example a student, a homemaker, or someone between jobs, the non-earner benefit may apply where you suffer a complete inability to carry on a normal life.

This also became an optional coverage on 1 July 2026, so it is worth confirming whether your policy carries it.

It is a demanding test, and documenting how thoroughly your ordinary life has been disrupted is exactly what our functional assessments are designed to do.

Where injuries are serious, benefits may cover personal care and help with household tasks. Attendant care is assessed on a Form 1, which must be completed by a qualified assessor. We coordinate this through our network of partner occupational therapists, who can also assess your home and recommend the equipment and modifications that make it safer to manage in.

Housekeeping and home maintenance benefits are generally available only where a catastrophic impairment has been determined, or where optional coverage was purchased.

A catastrophic impairment determination raises your medical and rehabilitation limit to up to $1,000,000.00 and opens access to attendant care and housekeeping benefits.

It requires a coordinated multidisciplinary assessment against defined criteria. We coordinate every specialist involved, conduct the psychological and functional components ourselves, and deliver one integrated report.

Ontario reformed its accident benefits system on 1 July 2026. It is the most significant change in decades, and most people are unaware of it.

Still mandatory in every policy: medical benefits, rehabilitation benefits, and attendant care. This is the funding that pays for counselling, physiotherapy, dietitian services, and assessments, so this category of coverage is unaffected by the reform. Approval for any specific treatment still depends on your diagnosed injuries and on the insurer agreeing it is reasonable and necessary.

Now optional, and only available if purchased: income replacement, non-earner benefits, caregiver benefits, housekeeping and home maintenance, visitor expenses, lost educational expenses, replacement of damaged property, and death and funeral benefits.

Policies that existed before 1 July 2026 renew with their current coverage unless the policyholder actively opts out in writing, so many people retain everything they had. Newer policies, and policies where someone chose to reduce coverage to save on premium, may not.

There is also a change in who can access the optional benefits. They now generally extend only to people named on a policy, which means a passenger, pedestrian, or cyclist without their own auto insurance may be limited to the mandatory medical, rehabilitation, and attendant care benefits.

Two practical suggestions. Ask your insurer or broker for your declarations page so you know exactly what you hold, and if you are reviewing your policy at renewal, think carefully before declining income replacement to save a small amount of premium. We are glad to explain what each benefit funds in practice, though we cannot advise you on insurance purchasing decisions.

You generally have two years from the date of the denial to start a dispute at the Licence Appeal Tribunal. That sounds like a long time, and people often let it slip because they assume the decision is final. It is not.

A denial is a position, not a verdict. Many are reversed when challenged with proper clinical evidence. Where treatment is denied we prepare the written response and provide the record behind it, so the dispute rests on documented evidence rather than on you arguing your case alone.

From receiving the forms. The window generally opens when your insurer provides the accident benefits package, not on the day of the collision. This is one of the most common misunderstandings, and it causes a great deal of unnecessary panic.

Two related traps. Do not wait passively for the package to arrive, because silence from an adjuster does not mean nothing is owed to you. And reporting only the damage to your vehicle may not be recorded as reporting an injury, which is what engages the insurer’s obligations.

It is still worth submitting late rather than not at all. If you cannot return it within the 30 days, send it anyway with an explanation of why. Filing very late can, in some circumstances, affect your ability to dispute a denial afterwards, which is another reason not to leave it.

Do not assume it is over. The Schedule allows relief where there is a reasonable explanation for missing a time limit, though that relief is not automatic and is decided case by case.

If you think you have missed something, speak to a lawyer promptly rather than giving up on the claim. Call us as well and we will help you work out where you stand.

Where you qualify for more than one weekly benefit, such as income replacement and non-earner, you have to elect which one you will receive. The OCF-10 is the form on which you make that choice.

It matters more than it looks, because the election is difficult to change afterwards and the benefits differ in amount and duration. This is a good example of a decision worth taking legal advice on before signing.

At the 104-week mark the test for income replacement becomes considerably stricter. For the first 104 weeks the question is whether you are substantially unable to perform the essential tasks of your own job. After that it becomes whether you are completely unable to engage in any occupation for which you are reasonably suited by education, training or experience.

Most disputes about income replacement happen at this point. What decides it is documented function, which is why ongoing assessment and clear reporting through the first two years matter so much.

Yes. They are two separate paths. Accident benefits come from your own insurer regardless of fault and fund your treatment and income support. A tort claim is a separate action against the person who caused the collision, for pain and suffering and for losses the benefits do not cover.

One does not prevent the other, and most seriously injured people pursue both. There are time limits on starting a tort claim, so it is worth speaking to a lawyer rather than leaving it.

Accident benefits are a no-fault coverage you have already paid for, and claiming them is not the same as being found at fault. Whether a premium changes depends on the fault determination and your insurer’s own rules, not on whether you sought treatment.

We raise this because fear of a premium increase is one of the most common reasons people delay claiming, and delay causes far more harm than the premium ever would. If you are worried, ask your broker before deciding.