SABS Changes 2026: A Claims Guide to Assessment Strategy Under Ontario’s New Accident Benefits Regime

Last updated: August 2026 | For claims professionals, TPAs, and defence counsel

Ontario Regulation 383/24 took effect on July 1, 2026, amending the Statutory Accident Benefits Schedule. Most published analysis of these amendments is written for consumers deciding what to buy at renewal. This guide is written for the people who administer the claims that follow.

The operational question is not what changed in the regulation. It is what changed in your assessment strategy: which assessments you still need, when you need them, whose eligibility you must confirm before commissioning them, and where the evidentiary record now has gaps that did not exist twelve months ago.

What actually changed

Three benefit categories remain mandatory on every Ontario auto policy: medical, rehabilitation, and attendant care. Everything else in Parts II, IV, V and VI of the SABS is now offered as optional coverage the named insured must actively purchase. That includes income replacement, non-earner, caregiver, and housekeeping benefits, along with lost educational expenses, visitor expenses, clothing and eyewear damage, and death and funeral benefits.

Alongside optionality, the auto insurer is now the first payer for accident-related medical and rehabilitation expenses, ahead of any supplementary health insurance plan. Section 47(2.1) of the SABS, added by O. Reg. 58/25, requires the auto insurer to pay those expenses notwithstanding that payment is reasonably available under a supplementary plan. The regulation defines a supplementary health insurance plan to include group plans sponsored by an employer or union or purchased through a professional association, and individual plans purchased from an agent, broker or insurer. Medication expenses are carved out and continue to be coordinated with collateral coverage first. OHIP-funded hospital and physician services are unaffected.

The trigger for this rule is different from the trigger for optionality, and the distinction matters on a mixed book. Optionality follows the policy: a policy issued after June 30, 2026 defaults to mandatory coverage only, while a renewed policy carries forward its prior coverage unless the named insured opted out in writing. The first payer rule follows the accident: it applies to any accident occurring in Ontario on or after July 1, 2026, whatever the policy’s inception date. A legacy policy with the full pre-reform benefit suite is therefore still a first-payer file if the accident occurred after the changeover. The transition period will produce a mixed book for years, not a clean cutover.

The practical effect is that treatment funding flows through the auto file earlier and on a larger share of the book than optionality alone would suggest, without the coordination delay that previously pushed early physiotherapy, occupational therapy and psychological care onto collateral plans.

Which SABS applies to this file

The single most common handling error in the transition period is treating the reform as one change with one trigger. It is two changes with two different triggers, and a file can sit on one side of one and the other side of the other.

Benefit availability follows the policy. A policy issued on or after July 1, 2026 defaults to the mandatory benefits only, unless the named insured actively purchased optional coverage. A policy that renewed on or after that date carries forward its existing coverage unless the named insured opted out in writing. The practical consequence is that a claimant injured in 2027 may hold richer coverage than a claimant injured in 2026, depending entirely on inception and renewal dates. The accident date tells you nothing about benefit availability, and assumptions drawn from it will be wrong on a substantial share of the book for years.

First payer status follows the accident. Section 47(2.1) reaches any accident occurring in Ontario on or after July 1, 2026, regardless of when the policy incepted. A file can therefore be a legacy-coverage file and a first-payer file at the same time, and frequently will be.

Two dates, two determinations, and they do not move together.

What first payer status changes operationally

Under the previous coordination regime, early treatment often reached the auto file only after a supplementary plan had absorbed the first tranche of physiotherapy, occupational therapy or psychological care. That coordination introduced a lag, and the lag had a side effect: by the time the auto insurer was funding treatment, a partial treatment record already existed, generated by someone else.

That lag is gone. The auto insurer now sees treatment demand at the front of the claim, funds it from the outset, and adjudicates it without the benefit of a pre-existing record assembled elsewhere. Three consequences follow for assessment planning.

Treatment plan volume arrives earlier and in greater quantity, because there is no collateral plan absorbing the initial requests. The section 38 clock runs on all of it.

The evidentiary basis for early denials is thinner than handlers may be used to. Where a supplementary plan previously generated some contemporaneous documentation of the claimant’s early presentation, the auto file may now be the only record, and it will contain only what the insurer commissioned.

The window in which an early functional or treatment-necessity assessment is useful opens sooner. An assessment commissioned on the old timetable may arrive after several months of funded treatment that was never independently evaluated.

Establishing the position on a live file

Confirm three things before assessment planning begins: the policy inception or renewal date, which governs benefit availability; the accident date, which governs first payer status; and whether an OPCF 47R endorsement is on file, which records what optional coverage was purchased or declined. Where the endorsement is absent on a post-June-2026 policy, treat the file as mandatory-only until documentation confirms otherwise, rather than the reverse.

Document the determination on the file when it is made. It will be revisited during the claim, and reconstructing the coverage analysis eighteen months later from renewal correspondence is materially harder than recording the conclusion at the time.

The eligibility question you must answer before commissioning anything

The most consequential operational change is not which benefits are optional. It is who can access them even when they were purchased.

Section 28 of the SABS restricts optional benefits to the named insured, the named insured’s spouse, the dependants of either, and persons specified in the policy as drivers of the insured automobile. Everyone else is outside the optional coverage entirely, regardless of what the policy contains.

That exclusion captures a large population. Most occupants who are not listed drivers fall outside it. All pedestrian claimants fall outside it. And the category that matters most in volume terms is fleet policies, where the named insured is typically a numbered corporation with no spouse, no dependants, and frequently no listed drivers. Company vehicles, transport trucks, buses, municipal and emergency vehicles, taxis, rental cars, and rideshare vehicles all sit in this category. For claimants injured in those vehicles, the only route to optional benefits is qualifying as a deemed named insured under the “regular use” provision at s. 3(7)(f).

For claims handling, this creates a verification step that should now precede assessment planning on every file. Confirming the policy, the claimant’s status under s. 28, and any deemed named insured argument determines which benefits are live, which determines which assessments are worth commissioning at all. Commissioning an income replacement assessment on a file where the claimant was never eligible for the benefit is pure leakage, and it is an error that becomes easy to make during a transition period when two regimes run in parallel.

How the assessment mix shifts

Uptake of optional coverage in Ontario has historically been low. The only publicly available data comes from insurer submissions to the Ontario government in 2019 concerning the optional catastrophic limit, which showed take-up rates in the single digits at most insurers and above fifteen percent at only one. That product is not the same as the benefits made optional in 2026, and the reforms are accompanied by broker disclosure obligations that did not previously exist, so the figures are indicative rather than predictive. Planning assumptions should nonetheless treat low uptake as the base case, with renewal carry-forward keeping legacy coverage alive on a substantial share of the book for some years.

The consequence is a redistribution rather than a contraction. Assessment volume tied to income replacement and non-earner benefits will thin as those benefits disappear from newly issued policies. That directly reduces the s. 44 insurer examination volume historically generated by weekly benefit adjudication.

Assessment volume tied to the mandatory categories becomes proportionally more important, and arguably more scrutinised. Medical, rehabilitation, and attendant care are now the only guaranteed pool, the auto insurer is the first payer into that pool, and disputes over what is reasonable and necessary remain fully live. Attendant care assessments and Form 1 work, functional abilities evaluations supporting treatment plan adjudication, and psychological and physiatry opinions on treatment necessity all sit in the part of the system that did not shrink.

Catastrophic impairment determination is unchanged by the amendments and gates access to the enhanced benefit pool. As the surrounding benefit structure narrows, the CAT determination becomes a larger share of the total value at stake on serious files, which tends to mean more rigorous challenge to the assessments underpinning it on both sides.

The three mandatory benefit categories

Medical, rehabilitation and attendant care are the benefits that survive on every policy issued after June 30, 2026, regardless of what the insured elected. For claims professionals, that concentration matters more than the list of what was removed. On a mandatory-only file, these three categories are the entire accident benefits claim, which means the assessment activity that supports or contests them is no longer one part of a broader adjudication — it is the adjudication.

Medical and rehabilitation

The non-catastrophic combined limit for medical and rehabilitation benefits remains $65,000, available for up to five years from the date of the accident. Nothing in O. Reg. 383/24 altered that figure. What changed is the proportion of the file it represents. On a policy where income replacement, non-earner, caregiver and housekeeping benefits are all absent, the medical and rehabilitation line is where every dispute now lands. A claimant who would previously have contested a denied income replacement benefit alongside a denied treatment plan now has only the treatment plan to contest, and will contest it harder.

The practical consequence is volume. Expect more OCF-18s per file, submitted earlier, with more of them escalating rather than being abandoned. Adjusters who have historically triaged treatment plan disputes as lower-value than benefit disputes will need to revisit that instinct, because on a mandatory-only file there is no higher-value dispute waiting behind it.

The Minor Injury Guideline becomes the primary battleground

This is the change most likely to be underestimated. The Minor Injury Guideline caps medical and rehabilitation benefits at $3,500, inclusive of assessment costs, where the impairment is predominantly a minor injury. Against a $65,000 limit, MIG designation has always been consequential. Against a claim where medical and rehabilitation is the only surviving benefit, MIG designation is close to determinative of the entire accident benefits exposure.

That raises the stakes on both sides of the determination, and it raises them asymmetrically. A claimant seeking to escape the MIG is now arguing for the difference between $3,500 and the whole of their remaining recourse under the policy. The volume of MIG-escape attempts on mandatory-only files should be expected to rise, along with the sophistication of the medical evidence supporting them — particularly submissions relying on pre-existing conditions that would prevent maximal recovery within the guideline, and on psychological sequelae asserted as independent of the physical injury.

The assessment implication is that the reports supporting or contesting a MIG designation now carry disproportionate weight relative to their cost. A $3,500 cap is decided on evidence that may cost a fraction of that to produce, but the decision governs the file. Commissioning a thin assessment on a contested MIG file is a false economy that will be tested at the Licence Appeal Tribunal, and the assessment cost itself counts against the cap, which compounds the pressure to get it right the first time rather than sequencing multiple narrow examinations.

Where a MIG designation is genuinely contestable — a documented pre-existing condition, a credible psychological component, an injury classification that sits at the boundary of the guideline — the assessment should be scoped to address the escape argument directly rather than simply confirming the physical diagnosis. A report that establishes the injury is a sprain, without addressing the pre-existing condition argument the claimant has already put in writing, does not resolve the dispute it was commissioned to resolve.

Treatment plan adjudication

Section 38 requires the insurer to respond to a treatment and assessment plan within ten business days of receipt, identifying which goods and services are approved and which are not, and giving the medical reasons for any refusal. Miss the window and the insurer is liable for the cost of treatment incurred from the eleventh business day until a proper denial is issued. That obligation is unchanged, but the ten-day clock now runs on a larger number of plans, arriving earlier in the claim because the auto insurer sits ahead of supplementary plans as first payer.

The standard being applied has not moved either: goods and services must be reasonable and necessary as a result of the accident. What has moved is how often that standard will be tested and how much rides on each test. Where a denial is going to be contested, the medical reasons supporting it need to be reasons an assessor has actually given, on a file the assessor has actually reviewed, within a scope the referral properly defined. A denial letter that recites a conclusion without an underlying report that supports it is the most common source of avoidable LAT exposure, and the first-payer change means these letters will be issued in greater numbers and under more time pressure than before.

Attendant care

Attendant care is the mandatory benefit that most often gets treated as a secondary consideration and most often produces surprise exposure. For non-catastrophic impairments the benefit is capped at $3,000 per month to a maximum of $36,000, payable for the first 104 weeks after the accident. Where the impairment is determined to be catastrophic, both the monthly amount and the 104-week limit change materially, and the assessment approach changes with them.

Entitlement is established through the Form 1 Assessment of Attendant Care Needs, completed by an occupational therapist or registered nurse. The Form 1 is a quantified instrument — it converts observed function into hours and dollars — which makes it unusually susceptible to methodological challenge, and unusually durable when the methodology is sound. Two assessors examining the same claimant can produce materially different monthly figures depending on how they interpret the level of assistance required and how they treat tasks a family member is already performing.

On a mandatory-only file, attendant care is also the benefit most likely to absorb claimant need that would previously have been distributed across caregiver and housekeeping benefits. Those benefits are gone from most new policies; the underlying need did not disappear with them. Expect Form 1 submissions that characterise as attendant care activities that would previously have been claimed elsewhere, and expect the boundary between personal care and household assistance to be tested more frequently than it has been. Commissioning an attendant care assessment on a serious file should therefore include an explicit instruction that the assessor distinguish personal care requirements from household and caregiving activity, because the distinction is now where the money sits.

The 104-week limit also deserves diary attention it has not always received. On a non-catastrophic file the attendant care benefit terminates at 104 weeks regardless of ongoing need, and a claimant approaching that boundary with continuing care requirements has an obvious incentive to pursue catastrophic determination. Files where attendant care has been paid at or near the monthly maximum should be flagged well before the 104-week mark, because a catastrophic application arriving at week 100 leaves no time to assemble a multidisciplinary response.

Catastrophic determination under a narrowed benefit structure

The catastrophic impairment provisions were not amended by O. Reg. 383/24. The eight qualifying categories under s. 3.1(1) remain in place, the enhanced limit remains at $1 million, and the non-catastrophic limit remains at $65,000. What changed is everything around them.

Under the previous structure, a catastrophic determination sat within a broader package of benefits. A claimant who did not meet the threshold still had access to income replacement, caregiver, housekeeping and other categories that provided meaningful support alongside the non-catastrophic medical and rehabilitation limit. On a mandatory-only policy, that surrounding structure is gone. The gap between a $65,000 non-catastrophic pool and a $1 million catastrophic pool is now, for many claimants, the entire difference between the available support and none.

The predictable consequence is that catastrophic determinations will be pursued more often, contested more vigorously, and scrutinised more closely on both sides. Files that would previously have settled into the non-catastrophic stream without serious challenge now carry a much stronger incentive to test the threshold.

For assessment planning, several implications follow.

Lead time matters more than it did. A catastrophic determination under most of the eight categories requires a multidisciplinary assessment drawing on multiple specialties, and several categories depend on impairment measurements that cannot be validly taken until the claimant’s condition has stabilised. Commissioning late compresses the timeline at precisely the point where the file is most contested. On serious injury files, the catastrophic question should be identified early even where the assessment itself must wait.

Panel composition is an evidentiary decision, not a scheduling one. The categories engage different expertise — spinal cord and brain injury categories draw on physiatry, neurology and neuropsychology; the whole person impairment and mental and behavioural categories require assessors fluent in the applicable rating methodology. A panel assembled for availability rather than fit produces a determination vulnerable on the specific ground that the assessor lacked the qualification to opine on the category at issue.

Combined-effects analysis requires coordination. Several categories contemplate the aggregate effect of physical, cognitive and psychological impairment. That analysis cannot be produced by independent reports written in isolation and stapled together; it requires assessors working from a common record with a coordinating framework. Where a determination turns on combined effects, the coordination is the deliverable.

The determination survives the limit. An insured found catastrophically impaired must still establish entitlement to specific benefits, and the assessment record supporting the determination will be revisited as those individual entitlements are adjudicated. A determination assembled with only the threshold question in mind leaves the downstream adjudication under-evidenced.

Assessment commissioning: a decision framework

Under the previous regime, assessment planning could reasonably begin with the injury. A serious file generated a predictable sequence of examinations across multiple benefit categories, and the question was mostly one of timing and specialty selection.

That sequence no longer holds. Assessment planning now begins with the policy, because the policy determines which benefits are live, and the live benefits determine which assessments are worth commissioning at all. Working in the old order produces two failure modes: commissioning assessments for benefits the claimant was never eligible to receive, and failing to commission assessments early enough on files where no other contemporaneous evidence will ever exist.

The sequence below reflects the new dependency order.

Establish which SABS applies. Confirm the policy inception or renewal date, which governs benefit availability, and the accident date, which governs first payer status. These are two determinations, not one, and they do not move together — see which SABS applies to this file above.

Confirm the claimant’s status under s. 28. Optional benefits reach only the named insured, their spouse, the dependants of either, and persons specified in the policy as drivers of the insured automobile. Occupants who are not listed drivers, and all pedestrian claimants, fall outside optional coverage regardless of what the policy contains. On fleet policies the named insured is typically a corporation with no spouse, no dependants, and frequently no listed drivers, which leaves the deemed named insured route under s. 3(7)(f) as the only available path. Resolve this before planning, not after.

Review the OPCF 47R endorsement. The endorsement records which optional benefits were purchased or declined and addresses priority of payment. It is the primary documentary artifact for coverage verification and should be on file before any assessment is commissioned against an optional benefit.

Map the live benefits to assessment types. Only once the first three steps are complete does the question become clinical.

Live benefit	Assessment focus	Timing consideration
Medical and rehabilitation	Treatment plan necessity, diagnosis, causation	Earlier than historically, given first-payer funding flow
Attendant care	Form 1 assessment, functional dependency	Trigger on care request or significant injury indicators
Income replacement, where purchased	Functional abilities, work capacity	Standard adjudication cycle
Catastrophic impairment	Multidisciplinary determination	Long lead time; commission early on serious files
Tort exposure, regardless of AB coverage	Defence medical	Substantially earlier where AB is mandatory-only

Flag the evidence gap. Where the file carries mandatory benefits only, note it for the tort side immediately. That file will generate no s. 44 examination record during the early recovery period, and the defence medical becomes the sole source of contemporaneous independent evidence. The scheduling decision that follows belongs to litigation, but the flag belongs at intake.

Scope for a single properly-constructed examination. The s. 44 frequency limitation means the file that once supported three sequential examinations may now support only one, so scope the assessment to address the mandatory benefits comprehensively the first time rather than planning to return. The reasoning is set out in the section on s. 44 in the new environment.

Instructing the assessor

Choosing the right assessment type is the first half of commissioning. The second half is asking a question the assessor can answer, and it is the half that most often determines whether the report is usable.

A referral that asks whether treatment is “reasonable and necessary” asks the assessor to state the legal conclusion the adjudicator must reach. A well-constructed report will decline to do so directly, or will do so in terms that add nothing, because that determination belongs to the insurer and ultimately to the Tribunal. The useful referral asks the clinical questions that support the determination: what is the diagnosis, what impairment is attributable to the accident, what functional limitations are demonstrated on examination, what treatment is clinically indicated for the diagnosed condition, what is the expected trajectory, and whether the proposed goods and services are consistent with the presentation. Those are questions within the assessor’s competence, and the answers give the adjudicator what the decision requires.

Scope the referral to the discipline. An orthopaedic assessor asked to opine on psychological barriers to recovery will either decline, weakening the report’s apparent completeness, or answer, weakening its defensibility. Where a file genuinely spans disciplines, the answer is a properly constituted multidisciplinary assessment with a coordinating framework, not a single assessor asked to range beyond their expertise.

Send the record, and send it complete. An assessment conducted on partial records is vulnerable on the ground that the assessor did not have the material necessary to form the opinion, and that vulnerability is entirely within the commissioning party’s control. Where records are incomplete because they have not been produced, say so in the referral so the report can document the limitation rather than appear to have overlooked it. Selective disclosure — sending the records that support a preferred outcome — is the single most damaging thing a commissioning party can do to its own evidence, because it converts a clinical dispute into a credibility dispute.

Identify the specific benefit or entitlement in issue. On a mandatory-only file this is narrower than it once was, and precision here does double duty: it produces a focused report, and on a section 44 examination it is a procedural requirement in its own right.

State the deadline and the format required. An assessor who does not know a report is needed for a Tribunal deadline cannot prioritise accordingly, and a report that arrives in a form requiring substantial reformatting for disclosure has consumed time the file did not have.

Finally, resist the instinct to signal the desired conclusion. Referral language that telegraphs an expected outcome is discoverable, it is routinely put to the assessor in cross-examination, and it taints an otherwise sound report. The commissioning party’s interest is in a report that survives challenge, which means a report that reads as though the assessor reached the conclusion independently — because they did.

Commissioning under the new structure? RIDM’s assessment coordinators can scope a referral to the live benefits on your file. Contact us.

The s. 44 insurer examination in the new environment

Section 44 of the SABS remains the mechanism by which an insurer requires an independent examination, and the procedural requirements attached to it have not relaxed. What has changed is the consequence of getting them wrong.

Three requirements deserve attention. Section 44(5) requires notice setting out the medical and other reasons for the examination. Section 44(6) requires the insurer to specify the benefit entitlements being assessed at least five business days before the examination, and the LAT has limited the use of IE reports where that notice was deficient. Section 44 also requires the insurer to provide a copy of the report to the insured person within ten business days of receiving it.

The frequency limitation is the one most likely to bite in the new environment. An insurer may require examinations by health professionals of its choice, but only as often as is reasonably necessary. With fewer benefit categories in play, the justification for repeat examinations narrows correspondingly — an insurer that would previously have commissioned separate examinations across income replacement, non-earner, and treatment adjudication now has a single mandatory category to work with, and a second or third examination within it will attract scrutiny it might previously have avoided.

The practical implication is that examination planning should be front-loaded. Where a file historically supported sequential examinations across several benefit categories, the justification for the second and third examination now has to be found within a single mandatory category, and it will not always be there.

The early evidence gap, and why defence medical timing should move

The reports produced under that mechanism served a second purpose that has gone largely unremarked.

Under the previous regime, a tort defendant could ordinarily obtain the accident benefits insurer’s s. 44 insurer examination reports through a discovery undertaking. Those reports were generated during weekly benefit adjudication, which meant they documented the claimant’s condition and function within roughly one to three years of the accident. They were contemporaneous, they were produced for a purpose other than the tort litigation, and they were often the most useful objective record of the claimant’s early trajectory.

When income replacement and non-earner benefits are not in force, that adjudication does not happen and those reports are never created. The tort defendant’s earliest medical evidence becomes the defence medical examination, typically conducted four to six years post-accident, by which point the claimant’s presentation has consolidated and the early recovery period is reconstructed from memory and treating records rather than documented by an independent examiner at the time.

A related consequence follows on the exposure side. Claimants without income replacement coverage may return to work prematurely or defer rehabilitation in the early weeks after an accident. Where that affects recovery, the resulting damages tend to migrate into the tort claim as larger past and future income loss and care cost claims, carried by the tort defendant’s insurer with prejudgment interest and costs attached.

The practical implication for litigation managers and defence counsel is that defence medical scheduling should move materially earlier on files where the accident benefits claim is limited to mandatory benefits. Waiting for the traditional pre-trial window now means accepting a documented gap in the period that most affects quantum. On files with serious injury and no optional coverage, an early defence medical is no longer a scheduling preference. It is the only mechanism that will produce contemporaneous independent evidence at all. Tort files should also be reserved and assessed with the migration of damages described above in mind.

Defensibility: what makes an assessment survive scrutiny

Defensibility standards are worth revisiting during a transition period. FSRA’s 2026-27 Statement of Priorities consultation attracted direct submissions on the oversight of assessment quality in Ontario, and the durability of an assessment at the Licence Appeal Tribunal continues to depend on examiner qualification, methodology, and the independence of the assessment provider. Where assessment volume concentrates into fewer, higher-value determinations, the cost of a report that fails under challenge rises accordingly. On a routine file, a weak report was one input among many. On a mandatory-only file where a single multidisciplinary assessment carries the adjudication, it is the adjudication.

Defensibility is often discussed as though it were a property of the individual assessor. It is more usefully understood as a property of the process that produced the report, and it fails in identifiable ways.

Procedural compliance. The most common reason an examination report is limited or excluded has nothing to do with its clinical content. Notice that fails to set out the medical and other reasons, notice that does not specify the benefit entitlements being assessed within the required period, and reports not distributed within the required window all create grounds for challenge that no amount of clinical rigour repairs.

Assessor qualification for the specific question. A qualified specialist is not automatically qualified for the question asked. An assessor opining outside their area of expertise, or applying a rating methodology they are not credentialed in, produces an opinion that can be dismantled without engaging its substance.

Methodological transparency. A report that states conclusions without documenting the basis for them — records reviewed, testing administered, findings on examination, reasoning connecting findings to conclusions — invites the inference that the conclusion preceded the analysis. Reports that show their work survive cross-examination; reports that assert do not.

Scope discipline. Opinions extending beyond the question posed, or beyond what the examination could support, undermine the credibility of the opinions that were properly within scope.

Structural independence. This is the criterion most often stated and least often examined. An assessment provider that also operates treatment clinics has a commercial relationship with the treatment side of the same system it is evaluating. That relationship may never influence an individual report, but it is a question that can be put to the assessor, and it is a question that becomes harder to answer as consolidation increases in the Canadian assessment market. Independence that is structural rather than merely asserted is not a marketing distinction; it is one fewer line of challenge.

Accreditation as a process control. Third-party accreditation matters here for a specific reason: it evidences documented, audited processes for assessor credentialing, report review, complaint handling and quality assurance. That documentation is what allows a provider to demonstrate that a given report was produced under a controlled process rather than assert that it was. CARF accreditation, which RIDM has held for its assessment services, requires exactly this kind of documented process discipline.

An assessment vendor should be able to answer, on request: how assessors are credentialed and matched to referral questions, what report review occurs before release, what the addendum and clarification rate is, and how conflicts are identified and managed. A provider unable to answer those questions is not necessarily producing weak reports, but it cannot demonstrate that it is not.

Reviewing your assessment panel for the new environment? Request RIDM’s IME vendor due diligence framework — the questions to put to any provider before your next referral. Download it here.

Common commissioning errors in the transition period

The errors below are predictable consequences of applying pre-July-2026 habits to post-July-2026 files. Most are avoidable at intake.

Assuming coverage from the accident date. Benefit availability follows the policy, not the collision. A 2027 accident on a policy that renewed with carried-forward coverage may support benefits that a 2026 accident on a newly issued policy does not.

Assuming first payer status follows the policy. It does not. Section 47(2.1) is triggered by the accident date, which means legacy-coverage files with post-July-2026 accidents are still first-payer files.

Commissioning against a benefit the claimant cannot access. This is the most expensive error available in the current environment. An income replacement assessment on a fleet-policy occupant who is not a listed driver produces a report addressing a benefit that was never in play. The cost is not only the assessment fee but the delay, and on a disputed file, the appearance of a poorly-managed process.

Under-specifying the s. 44 notice. The notice must set out the medical and other reasons for the examination and must specify the benefit entitlements being assessed at least five business days beforehand. Notices drafted from templates built around the old benefit structure may reference entitlements that no longer exist on the file, which is both inaccurate and an avoidable ground for challenge.

Missing the report distribution window. A copy of the examination report must go to the insured person within ten business days of the insurer receiving it. Administrative slippage here is unforced and entirely preventable with a calendared trigger.

Sequencing examinations out of habit. Splitting what could be one multidisciplinary assessment into several narrow ones now carries real risk under the frequency limitation, where previously it was merely inefficient.

Treating the tort file as a later problem. On mandatory-only files, deferring the defence medical to the traditional pre-trial window guarantees a documentary gap across the period that most affects quantum. The decision to schedule early has to be made while the period is still current.

Failing to document the coverage determination. Where eligibility under s. 28 was contested or resolved through a deemed named insured analysis, the reasoning should sit on the file. It will be revisited, and reconstructing it later is materially harder than recording it at the time.

Looking ahead to Alberta

Ontario is not the only jurisdiction restructuring in this cycle.

Alberta’s Care-First model takes effect January 1, 2027, substantially restricting tort recovery in favour of expanded no-fault benefits. The right to sue is preserved in narrow circumstances, principally where the at-fault driver is convicted of a Criminal Code driving offence, and recovery in those cases remains limited. The assessment consequences run in a different direction than Ontario’s — away from plaintiff and defence tort medicals and toward benefits adjudication, functional capacity evaluation, and return-to-work assessment.

National carriers writing in both provinces will be managing two divergent assessment models simultaneously from the start of 2027.

RIDM has conducted certified examinations in Alberta since before the reform was announced and is preparing assessment capacity for the Care-First transition.

Frequently asked questions about the 2026 SABS changes

Does the July 2026 reform change what benefits my claimant is entitled to on an accident that happened last year?

No. Benefit availability follows the policy in force at the time of the accident. An accident occurring before July 1, 2026 is governed by the coverage that policy provided.

A claimant was injured in August 2026 on a policy that renewed in March 2026. What coverage applies?

The March renewal carried forward the pre-reform benefit suite unless the named insured opted out in writing, so the full range of benefits is likely available. The first payer rule nonetheless applies, because the accident occurred after July 1, 2026.

Does the first payer rule apply to policies issued before July 1, 2026?

Yes. Section 47(2.1) is triggered by the accident date, not the policy date. Any accident occurring in Ontario on or after July 1, 2026 engages the rule regardless of when the policy incepted.

Are medication costs covered by the first payer rule?

No. Medication expenses are expressly carved out of s. 47(2.1) and continue to be coordinated with supplementary coverage in the usual way.

Can an occupant of a company vehicle access optional benefits?

Generally not through the policy alone. Section 28 restricts optional benefits to the named insured, their spouse, the dependants of either, and persons specified in the policy as drivers. On a fleet policy the named insured is typically a corporation, so an occupant who is not a listed driver must establish deemed named insured status under s. 3(7)(f) to reach optional coverage.

Did the reform change the catastrophic impairment definition or limits?

No. The eight qualifying categories under s. 3.1(1) and the enhanced limit are unchanged. What changed is the surrounding benefit structure, which makes the determination more consequential and more likely to be contested.

Does the Minor Injury Guideline still apply?

Yes, and its practical significance has increased. The $3,500 cap, inclusive of assessment costs, now applies to what may be the only benefit category available on the file.

How often can an insurer require a section 44 examination?

As often as is reasonably necessary, and no more. With fewer benefit categories in play, the justification for repeat examinations within a single category is narrower than it was, which favours a single properly scoped assessment over a sequence of narrow ones.

How long does an insurer have to respond to a treatment and assessment plan?

Ten business days from receipt, identifying which goods and services are approved and giving medical reasons for any refusal. Failure to respond within the window creates liability for treatment incurred from the eleventh business day until a proper denial issues.

Should defence medical timing change on mandatory-only files?

Yes. Where the accident benefits claim is limited to mandatory benefits, no section 44 examination record will be generated during the early recovery period, and the defence medical becomes the only source of contemporaneous independent evidence of that period.

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Assessments under the new regime

RIDM has provided independent assessment and disability management services across Canada since 1986. We are CARF-accredited, Canadian-owned, and independent of any treatment provider network. If you are reviewing your assessment strategy for the post-July-2026 environment, get in touch.

This guide is general information about regulatory change and is not legal advice.

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