Major changes to the Statutory Accident Benefits Schedule (SABS) came into effect in Ontario July 1st – applying to all customers. These Auto Reform changes are aimed at providing more control and options for consumers in their accident benefits coverages. The changes limit mandatory benefits, provide coverage options to customers, and affect who can access benefits after a motor vehicle accident.
These changes greatly impact our adjusting work in Ontario.
From an accident benefit perspective, Janet Annis, VP of Ontario South and Ontario Accident Benefits states: “We knew these changes would significantly impact how claims are investigated and managed, so we focused on preparing our people first. Now that the reforms are in effect, we're already seeing new questions around coverage, priority, and benefit entitlement, and our teams are ready to help clients navigate the road ahead.”
One of the biggest impacts in this new environment is understanding which version of the policy applies, whether optional benefits exist and who is eligible to claim the optional benefits. In addition, with the elimination of Endorsement OPCF 47 – Agreement Not to Rely on Priority of Payments Rules, understanding priority of payments. As these changes begin to take effect in real claims, adjusters are finding that thorough coverage analysis, clear communication, and early identification of exposures are critical to successful claim resolution.
Given the significant reduction in standard Accident Benefits coverage, we anticipated an increased focus on tort exposures and bodily injury claims. As a result, it was important that our Auto Reform training extended beyond Accident Benefits and included our Bodily Injury Adjusters to ensure they were equally prepared for the changes.
From a liability perspective, Jeni Hamu, District Manager GTA / Burlington Branch Manager, states: “ When Accident Benefit coverage is absent for claimants, liability claims surge. Claimants needing recovery are already pursuing every available third party – naming any potential tortfeasor to see what sticks. Expect earlier and more aggressive litigation as plaintiffs look for anyone who can foot the bill previously supported by available Accident Benefits coverage. Early and accurate exposure recognition and thorough investigation are imperative as we navigate liability last post Auto Reform.”
It’s a whole new world of increased variation in limits, benefit types, eligibility rules, and priority of payment, with files requiring policy-level scrutiny.