Medical Treatments under Ontario No-Fault Benefits: What’s Covered and What’s Not

September 11, 2025, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Medical costs are often the heart of no-fault claims after an Ontario auto accident. Understanding what’s covered—and how to obtain it—can prevent surprise bills and delays in recovery.

What’s commonly covered

Ontario’s SABS  generally covers medically necessary treatment related to the crash. This includes visits to physicians, specialists, physiotherapy, occupational therapy, chiropractic care, and certain diagnostic services. In addition, rehabilitation programs and therapies aimed at improving function and reducing pain are typically eligible if they’re deemed reasonable and necessary. These benfits have CAPPED dollar value limits that you should be aware of immediately.

If you find yourself needing medical treatments you should contact one of our personal injury lawyers who will evaluate your case and guide you through the process.

Medical necessity and pre-authorization

Insurers often require justification that a treatment is medically necessary and within the approved scope of benefits. Pre-authorization may be necessary for some therapies or providers. Keeping a clear line of communication with your insurer and your treating providers helps ensure continuity of care.

Choosing doctors and providers

In most cases, you can choose your own doctors and therapists, but coverage may be contingent on treatment being provided by approved professionals or facilities. Your lawyer can help you navigate provider networks and, if needed, advocate for access to essential specialists.

Billing, out-of-pocket costs, and timelines

Facilities and practitioners will bill the insurer directly for approved services. You may still incur out-of-pocket costs for non-covered services or if coverage caps apply. Timelines matter; delayed documentation can slow reimbursement. A well-organised medical record and communication with your insurer help prevent delays. Our experienced team will help you navigate these rough times.

Disputing coverage decisions

If your insurer denies or delays coverage for a treatment you believe is necessary, you can request a reconsideration or appeal. It helps to have a detailed medical rationale, supporting reports, and a clear statement of how the treatment supports your recovery goals. our personal injury lawyers can assist with strategy, documentation, and communications.

Our Role

Our team reviews your medical needs in the context of SABS, negotiates with insurers, and helps you access appropriate care promptly. We can identify gaps in coverage, gather supporting medical evidence, and pursue appeals when necessary to protect your recovery plan.

Next steps

If you’re unsure whether a treatment is covered, contact us immediately for a free review of your medical benefits. We’ll translate policy language, communicate with your providers, and ensure your treatment plan aligns with your recovery goals.

About Deutschmann de Koning Law

Deutschmann de Koning Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann and Nick de Koning focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.ddinjurylaw.com or call us at 1-519-742-7774.