7.1 SABS Structure & Accident-Benefit Choices After July 1, 2026

Section 4 and no-fault benefits

Section 4 of the Ontario Automobile Policy points insured persons to the Statutory Accident Benefits Schedule (SABS). These first-party benefits can respond to eligible automobile-accident injuries without requiring the claimant first to prove that another driver was at fault. That does not mean every expense is automatically payable. The claimant, accident, service, amount, timing, and documentation must satisfy the current SABS and policy.

Accident benefits are distinct from third-party liability, tort damages, uninsured automobile coverage, and travel medical insurance. A broker should explain the categories without trying to adjust a claim or give medical or legal opinions.

The July 1, 2026 change

FSRA's reform applies to new and renewing policies effective on or after July 1, 2026. Under that framework, the mandatory accident-benefit core is:

• medical benefits;
• rehabilitation benefits; and
• attendant care benefits.

The other statutory accident benefits are optional choices. These can include income replacement, non-earner, caregiver, housekeeping and home maintenance, death, funeral, lost educational expenses, expenses of visitors, and damage to clothing, glasses, hearing aids, and other specified personal items, as organized by the current selection process.

This is a major date-sensitive distinction. Older material describes a broader mandatory package with optional increases. For a scenario, identify the policy's effective or renewal date and the actual selections. Do not use a pre-reform default answer for a post-reform policy.

OPCF 47R and priority

The reformed process uses OPCF 47R—Optional Accident Benefits and Priority of Payment. It records optional accident-benefit choices and addresses priority relative to another plan that may cover the same type of loss. Priority is not the same as declaring another plan equivalent. Employer disability, workplace health, pension, credit-card, and private health arrangements differ in eligibility, duration, offsets, taxation, definitions, and continuity.

The broker should confirm the current insurer forms and workflow, explain the available packages or selections, and retain the client's authorized instruction. Do not invent a universal separate waiver, permanent-retention period, or identical electronic process for every insurer. The approved endorsement and the brokerage's compliant transaction record are the starting points.

Needs-based benefit advice

For income replacement, explore employment and self-employment income, sick leave, employer disability plans, waiting periods, benefit amounts, offsets, job changes, and how long the household can fund an interruption. Avoid assuming that a group plan will always respond or continue.

For non-earner protection, consider people without an employment-income claim who may nevertheless suffer a serious loss of normal function. For caregiver and housekeeping/home maintenance, identify unpaid responsibilities and the realistic cost of replacing them. For death and funeral choices, examine dependants, estate resources, debts, and other life or group coverage without presenting general insurance advice as comprehensive estate planning.

For visitor, education, and personal-item benefits, explain the defined purpose and limits from the current wording. A low premium saving should not be presented without the financial protection given up.

Other insured persons and policy coordination

SABS can protect more than the named insured. The current policy and legislation define insured persons and priority where the claimant is a spouse, dependant, occupant, pedestrian, cyclist, or connected to more than one policy. Territorial and priority questions can be technical. Identify the person's relationship, where the accident occurred, whether they occupied an automobile, and all potentially applicable policies, then report through the appropriate insurer channel.

Do not confuse benefit selection priority under OPCF 47R with the separate statutory rules determining which automobile insurer receives a claim. The detailed priority chapter addresses that distinction.

A compliant client conversation

Use a repeatable process:

1. identify the effective date and whether the reformed framework applies;
2. obtain facts about income, roles, dependants, other plans, and ability to retain loss;
3. explain the mandatory core and each relevant optional protection in plain language;
4. compare benefit choices and premium effects without promising another plan will pay;
5. answer within competence and obtain insurer clarification where necessary;
6. complete the current selection and OPCF 47R process;
7. confirm the final selections and any priority effect; and
8. reconcile the issued policy and endorsement.

The client may choose less protection after receiving competent advice. The broker's role is to make the choice informed, accurate, and properly implemented—not to coerce the client or manufacture a form that current rules do not require.

Use FSRA's current accident-benefit reform guidance and approved forms when advising or studying.