Dale Orlando highlights how legislative cuts to accident benefits fail Ontario's most vulnerable
This article was produced in partnership with McLeish Orlando.
Dale Orlando could share hundreds of stories about the many ways the current Statutory Accident Benefits Schedule (SABS) has fallen short of its intended purpose for those he’s represented. In one recent case, a young man had his legs crushed by another car that pinned him against his own vehicle as he was unloading groceries from the trunk.
Though it was clear he would eventually require amputation — “The debate wasn’t whether he’d ever be able to ambulate normally,” Orlando says, calling his client a very smart young man with a bright career in engineering ahead of him — without officially having the surgery performed, he didn’t meet the test for catastrophic designation. Once someone has an amputation, they’re automatically considered catastrophic.
What that means in practical terms is that the client only had access to the $65,000 entitlement for non-catastrophic injuries under the schedule. That is a combined limit for medical, rehabilitation, and attendant care needs that was established under the 2016 legislative amendments, which clawed back many of the resources available to injured Ontarians — especially those requiring intensive or ongoing care.
“Someone with shattered knees requiring extensive surgeries and hardware receives the same amount as someone with a clean tibial fracture that will heal completely in six months,” Orlando explains. “The former, like my client in this case, will run out of funds long before their medical and rehabilitation needs have been met and it can take years to see if they qualify for additional benefits.”
The client flew his mother in from another country to provide unpaid care so he could use the money solely for medical and rehab needs. After two years and with that $65,000 long gone, Orlando’s client did undergo an amputation for his injured leg and was deemed catastrophic. But those 2016 amendments also slashed that entitlement, taking it to $1 million from $2 million — another significant scaling back of a system that was created to provide support and relief to those injured in motor vehicle accidents.
Noting that at the same time, the test for catastrophic was made more stringent, Orlando calls the changes made nearly a decade ago “a double whammy” for his firm’s clients. Dealing mostly with catastrophic injury claims, McLeish Orlando’s lawyers see far fewer people receive the catastrophic designation under the new test and those that do have access to $1,000,000 less in funding for their needs.
“I understand issues of affordability, but auto insurance savings should not come on the backs of the people that are the most seriously injured,” Orlando says, adding that the amendments mean difficult conversations with clients.
“We’re forced to tell clients they really need to pick and choose what care they receive. Maybe they prioritize physiotherapy over psychological counseling, or rehab care over attendant care. Even then, with insurance digging in to dispute cat entitlement and the LAT process taking years to reach a decision on catastrophic — and overwhelmingly siding with insurers — the client is often long out of money.”
The 2016 amendments also saw changes to the dispute resolution process, removing costs payable and special awards at the LAT and leaving little to no consequences for insurers acting in bad faith. For clients who don’t receive a catastrophic designation immediately there are various tests that apply at different stages of recovery. Once a client has undergone the various assessments required and receives a consensus opinion that they meet one of the tests for catastrophic, the insurers often opt for a LAT hearing knowing they won’t have to pay any associated legal costs. And while the injured party often has coverage for up to 50% of the catastrophic assessments required, that still leaves a significant amount to cover out of pocket.
“Insurers can deny claims because the claimant bears the risk of fighting the decision,” Orlando says, adding that it used to be that an arbitrator who believed an adjuster failed in their duty of good faith could face a hefty sum.
“Now, there are no consequences of acting arbitrarily and unreasonably.”
In a perfect world, SABS would return to its pre-2016 form. Restoring higher limits and easier access to dispute resolution, Orlando says, would be more in line with the initial intent behind the benefits. But legislative changes continue to erode the schedule. The next round of changes takes effect July 1, 2026. While none of these directly address catastrophic entitlement, Orlando will once again have a front row seat to the real-life fallout.
Making nine out of 12 benefits — such as income replacement — optional instead of mandatory is positioned as providing consumers with more choice and cost savings, but Orlando argues this was already the case. For example, people could still choose to opt for $2 million in catastrophic coverage or $1000 a month instead of $400 for income replacement.
“The vast majority of people I speak to didn’t know there was optional coverage, and I don’t think that will change with these upcoming changes either,” Orlando says. “People tend to take the most cost-effective option and if they ever are injured, it’s a rude awakening.”
Though the system in its current state might fail the most seriously injured, McLeish Orlando does not. While many other firms don’t manage accident benefits at all — unless it’s a catastrophic claim from the start — and instead focus only on the tort side, McLeish Orlando is involved in every aspect the client’s journey.
“We take a different view; for us, the most important thing is people get care and treatment in a timely way,” Orlando explains.
The team at McLeish Orlando work closely with clients to help them prioritize the benefits they do have access to and connect them with the best professionals possible. With three decades of experience, the firm has worked with the best treatment providers in the province and knows who to recommend. The firm’s lawyers are also unafraid to go toe-to-toe with the other side of the table.
“We let insurers know we don’t approach the no-fault entitlement as a business: we have no problem pursuing a $1500 treatment plan that’s wrongly denied,” Orlando says. “We’ll spend as much legal time as we need pursuing that benefit.”
And clients facing tens of thousands of dollars in costs for the catastrophic assessments required do not have to worry about funding the costs of the assessments.
“Overwhelmingly, clients do not have the financial resources to fight insurers. We want them to have access to justice, so the firm funds all necessary disbursement,” Orlando sums up. “The no-fault system is meant to be user friendly but the results that clients receive on their own are quite lacking. In the absence of meaningful change, our firm is there for our clients through every step.”
