7.3 Optional Economic Benefits, Elections & SABS Priority
Key Takeaways
- For policies entered into on or after July 1, 2026, medical, rehabilitation, and attendant care remain mandatory; all other SABS categories are optional to purchase.
- The familiar income-replacement benchmark is 70% of gross income up to a selected weekly limit, but a claim exists only if the coverage was elected and the claimant meets the SABS test.
- Caregiver, housekeeping, non-earner, death, funeral, lost educational expense, visitor expense, personal-item damage, dependant care, and indexation choices require policy-specific review.
- OPCF 47R records optional accident-benefit coverage and priority-of-payment choices under the July 2026 framework.
- SABS insurer priority generally starts with the injured person's own named-insured policy, then a policy under which the person is an insured, with occupant and other statutory levels following as applicable.
The July 2026 decision point
Older study material describes income replacement and several other accident benefits as automatically included in every Ontario automobile policy. That is no longer a safe assumption. For a new policy entered into on or after July 1, 2026, only medical, rehabilitation, and attendant care benefits remain mandatory. Other accident-benefit categories must be offered but are optional for the consumer to purchase.
For renewing business, transition rules preserve existing choices in specified circumstances until the customer changes them. A broker must therefore check the effective date, renewal status, certificate, and endorsements rather than infer coverage from the accident date alone.
Optional benefit families
| Benefit family | Purpose | Broker discovery question |
|---|---|---|
| Income replacement | Replaces part of qualifying employment income | What income would stop, and what employer or disability protection exists? |
| Non-earner | Supports a qualifying person who suffers the required inability but does not qualify for income replacement | Is the person a student, unemployed, retired, or otherwise outside the income test? |
| Caregiver | Addresses qualifying inability to continue primary unpaid caregiving | Who depends on the person for care and what would replacement care cost? |
| Housekeeping and home maintenance | Addresses qualifying inability to perform usual household tasks | Who performs those tasks now and what paid replacement would be needed? |
| Death and funeral | Pays selected lump-sum and funeral benefits after a qualifying death | What life insurance, dependants, and final-expense needs exist? |
| Other options | May include lost educational expense, visitor expense, damage to personal items, dependant care, and indexation | Which exposures matter to this household and what does the insurer offer? |
Use the current insurer selection form and wording. Benefits, limits, definitions, and available packages may differ within the regulatory framework.
Income replacement as an elected benefit
FSRA's consumer material continues to describe an income-replacement option based on 70% of gross income up to $400 per week, with higher weekly options such as $600, $800, or $1,000. The selected limit is not a guaranteed payment. The claimant must have elected coverage, meet the eligibility and disability tests, supply required proof, and have the amount determined under the SABS rules.
Do not subtract a benefit such as Canada Pension Plan disability by memory. The SABS calculation distinguishes sources and applies detailed rules. On an exam or real file, identify the relevant statutory provision and use the current formula rather than a blanket "dollar-for-dollar" statement.
Non-earner, caregiver, and housekeeping choices
These benefits use distinct qualification tests and should not be treated as interchangeable. A person cannot simply choose whichever amount is largest after an accident. Eligibility, elections, impairment standards, and interactions are governed by the current SABS and selected policy options.
The July 2026 reform also changed the offering structure for caregiver and housekeeping coverage. Current FSRA guidance requires insurers to offer the legislated all-impairment option for applicable new-business quoting, while approved products may provide other choices. The broker should explain what is included, what is declined, and how the decision affects the household.
OPCF 47R and documentation
OPCF 47R is the new form for optional accident-benefit coverage and priority of payment. The broker should:
- identify the people and policies that may respond;
- explain each offered option in plain language;
- compare the selected limit with income, caregiving, health, and household needs;
- record the customer's selection or declination accurately;
- check the issued certificate and endorsement; and
- deliver the documents and retain the approved record.
The goal is informed choice, not coercion. A signed form supports the file, but it does not replace a competent explanation.
Insurer priority
Section 268 of the Insurance Act establishes a priority hierarchy for accident benefits. For an occupant or other injured person, the analysis commonly begins with whether the person is a named insured under a policy, then whether the person qualifies as an insured under another policy. Policies on the occupied automobile and other involved automobiles follow at later levels where the statute directs.
Example: an Ontario driver who owns an insured car is injured while riding in a friend's car. The injured person normally applies to the insurer under their own named-insured policy first. Fault for the collision does not decide SABS priority.
Exam method
For a post-reform question, ask four things in order: Was the benefit mandatory or optional on the relevant policy date? Was it elected? Does the person meet that benefit's eligibility test? Which insurer has priority? This avoids applying an old "standard package" to a current policy.
A new Ontario auto policy takes effect August 1, 2026. Which accident-benefit category remains mandatory?
Before estimating income-replacement benefits for a 2026 claim, what must the broker confirm first?
A named insured under their own Ontario auto policy is injured as a passenger in a friend's car. Which insurer is normally considered first for SABS priority?