This article explains everything you need to know about Attendant Care benefits in Ontario under the new rules, including what they cover, how to claim them, and what the 2026 changes mean for you and your family.
What Are Attendant Care Benefits?
Attendant Care Benefits (ACB) are a crucial component of Ontario’s Statutory Accident Benefits Schedule (SABS). They provide funding to pay for assistance with basic daily activities when you’re unable to perform them yourself due to injuries from a motor vehicle accident .
These benefits cover help with routine activities of daily living, including:
- Dressing and grooming
- Bathing and personal hygiene
- Eating and meal preparation
- Mobility assistance (getting in and out of bed, using a wheelchair)
- Toileting and incontinence care
- Supervision for safety (particularly relevant for brain injury survivors)
ACB can be used to hire professional caregivers or, under specific conditions, to compensate family members who provide care .
What’s Changing July 1, 2026?
The Ontario government’s reforms, introduced through Regulation 383/24, fundamentally restructure accident benefits . Here’s how Attendant Care is affected:
Attendant Care Remains Mandatory
Unlike many other benefits that become optional, Attendant Care (along with medical and rehabilitation benefits) will continue to be automatically included in every auto insurance policy . This ensures that all insured individuals have access to basic care assistance if catastrophically injured.
Better News: Insurers Become “First Payer”
A significant improvement under the new system is that auto insurers will now become the primary payer for mandatory medical, rehabilitation, and attendant care benefits . Previously, claimants had to exhaust other benefits first (such as workplace health plans or private insurance) before accessing auto insurance coverage. This change streamlines the process, reducing delays and administrative burden when you need care most .
What About Enhanced Coverage?
While basic Attendant Care is mandatory, you can still purchase supplementary attendant care benefits to increase your coverage limits beyond the standard amounts . This optional upgrade provides additional protection for those who want higher coverage limits.
Coverage Limits and Eligibility
Injury Classifications and Maximums
Under the current system (which continues under the new framework), Attendant Care benefits are capped based on injury severity:
Who Qualifies for Attendant Care?
To qualify for ACB, you must meet these criteria:
- Sustain injuries from a motor vehicle accident that impact your ability to perform daily activities independently
- Have medical confirmation from a doctor or occupational therapist documenting your care needs
- Incur reasonable and necessary care expenses
Important note: Minor injuries typically don’t qualify for ACB unless there’s additional medical evidence demonstrating severity .
Can Family Members Be Paid for Providing Care?
Yes, family members can receive compensation for providing attendant care, but specific requirements must be met:
Conditions for Family Compensation
- Proof of care provision: Family members must demonstrate they actually provided care (through care logs, schedules, etc.)
- Income loss documentation: If the family member gave up employment or reduced work hours to provide care, they need employer verification and income records
- Formal arrangements: Insurance companies often require care agreements or formal documentation showing the care arrangement
- Payment records: Bank transfers, receipts, or other proof of payment may be required
Compensation Amounts
If a family member provides care:
- Without professional qualifications: Compensation typically aligns with their actual lost income, not professional caregiver rates
- With professional qualifications (nurse, PSW): May qualify for higher, market-rate compensation
How to Apply for Attendant Care Benefits
Step-by-Step Application Process
Step 1: Submit OCF-1 (Application for Accident Benefits) – This initiates your insurance claim and must be submitted within 30 days of the accident (though late applications may be accepted with explanation) .
Step 2: Obtain Medical Assessment – Your doctor or an occupational therapist must complete OCF-18 (Treatment and Assessment Plan) , detailing your need for attendant care .
Step 3: Complete Form 1 (Attendant Care Needs Assessment) – An occupational therapist typically completes this comprehensive assessment, specifying the level and cost of care required .
Step 4: Submit Documentation – Provide all forms to your insurance company, keeping copies for your records.
Step 5: Insurance Review – Insurers typically take 10-30 days to review and respond . They may request additional information or independent assessments.
Required Supporting Documents
- Medical reports confirming injury severity
- Care plans from healthcare providers
- Care logs documenting daily assistance provided
- Receipts or payment records for care expenses
- Employment records (if family members lost income)
What Happens If Your Claim Is Denied?
If your insurance company refuses to pay Attendant Care benefits, you have options:
1. Request Reconsideration
Ask the insurer to review their decision, providing additional medical evidence or documentation supporting your need for care .
2. Independent Medical Examination
Sometimes a second opinion from an independent healthcare professional can strengthen your case .
3. Dispute Through FSRA
File a complaint with Ontario’s Financial Services Regulatory Authority (FSRA), which oversees insurance companies.
4. Legal Action
Consult a personal injury lawyer specializing in accident benefits. Legal representation significantly improves outcomes in disputed claims .
The Bigger Picture: 2026 Reforms and Their Impact
What Else Is Changing?
While Attendant Care remains mandatory, many other benefits become optional as of July 1, 2026:
Who’s Covered for Optional Benefits?
A critical change: optional benefits only apply to:
- The named insured
- Their spouse
- Their dependents (and spouse’s dependents)
- Listed drivers on the policy
This means pedestrians, cyclists, and passengers who aren’t listed on any policy won’t have access to optional benefits—though they still qualify for mandatory medical, rehab, and attendant care .
What This Means for You
- Review your policy: Understand what coverage you currently have and what you’ll need after July 1, 2026
- Check workplace benefits: You may already have some coverage through employer plans, avoiding duplication
- Consider your needs: Think about whether you need enhanced attendant care limits or other optional benefits
- Talk to your broker: Insurance professionals can explain options and help tailor coverage to your situation
Practical Tips to Maximize Your Attendant Care Claim
Do’s and Don’ts
Improving Approval Chances
- Be specific: Detailed care logs showing exactly what help you need and when strengthen your case
- Professional assessments: Occupational therapist evaluations carry significant weight with insurers
- Document everything: Save all medical records, assessments, and correspondence with your insurer
- Follow up: If you haven’t heard back within 30 days, contact your insurance company
Frequently Asked Questions
Does Attendant Care cover 24/7 nursing care?
For catastrophic injuries, benefits up to $6,000 monthly can contribute toward around-the-clock care, though this amount may not cover full-time professional nursing. Supplementing with other resources or enhanced coverage may be necessary .
Can I receive Attendant Care if I live with family?
Yes. Living with family doesn’t disqualify you from ACB. If family members provide care and meet the requirements discussed above, they can be compensated .
What’s the difference between Attendant Care and Caregiver Benefits?
These are often confused. Attendant Care covers personal care for you (bathing, dressing, etc.). Caregiver Benefits (which become optional in 2026) cover costs if you can no longer care for dependents like children or aging parents .
Will my premiums increase if I claim Attendant Care?
While accident claims can affect premiums, Ontario rules limit rate increases for no-fault benefits claims. However, multiple claims or at-fault accidents may impact your rates at renewal.
Do I need a lawyer to claim Attendant Care?
Not necessarily. Many claims proceed smoothly with proper documentation. However, if your claim is denied, underpaid, or involves catastrophic injury, legal representation helps protect your interests .
Summary: Key Takeaways
- Attendant Care remains mandatory in all Ontario auto policies after July 1, 2026
- Insurers become first payers, streamlining access to benefits
- Injury severity determines coverage: Up to $3,000/month (non-catastrophic) or $6,000/month (catastrophic)
- Family can be compensated if they provide documented care and suffer income loss
- Application requires medical forms (OCF-1, OCF-18, Form 1) and supporting documentation
- Review your coverage before July 2026 to ensure adequate protection, especially if you want enhanced limits
The 2026 reforms give Ontario drivers more control over their insurance costs and coverage. While Attendant Care’s mandatory status ensures a baseline of protection for those who need daily assistance after accidents, understanding how to access and maximize these benefits remains crucial. Take time before July 1 to review your policy, discuss options with your broker, and ensure you and your family have the protection you need.
Need help with an Attendant Care claim? Contact a personal injury lawyer specializing in accident benefits for personalized guidance.
