The answer is no — and yet that’s exactly what some Ontario auto insurers are demanding from injured accident victims and their caregivers. It’s time to call this out for what it is: unfair, and exploitative.
Section 19 of the SABS obligates auto insurers to pay Attendant Care Benefits incurred by or on behalf of a person injured in a motor vehicle accident.
The monthly amount of the attendant care benefit is determined using an “Assessment of Attendant Care Needs” (Form 1), completed by an occupational therapist or registered nurse. The form breaks care into 3 levels:
- Level 1 – Routine Personal Care
- Level 2 – Basic Supervisory Functions
- Level 3 – Complex Health/Care and Hygiene
The OT or RN determines how many minutes each task requires and how often it’s needed per week. That calculation drives the monthly benefit amount. Using the Superintendent’s Guideline No. 01/18, providers can also calculate the total monthly cost of services — but here’s where the system starts to break down.
Eight Years of Inaction
Guideline No. 01/18 became effective on April 14, 2018, eight years ago. The maximum hourly rates it established haven’t moved since:
- $14.90 (Level 1 – Routine Personal Care)
- $14.00 (Level 2 – Basic Supervisory Functions)
- $21.11 (Level 3 – Complex Health/Care and Hygiene)
Levels 1 and 2 are set below Ontario’s current general minimum wage of $17.95! These are rates meant to compensate trained Personal Support Workers, professionals who completed college-level certificate programs with classroom learning and clinical placements. These are not volunteers. They are skilled caregivers, and some insurers expect them to work for less than a cashier’s starting wage.
Insurers Are Twisting the Rules
Faced with this reality, some providers found a reasonable workaround: charge their fair market rate, but cap the total monthly bill within the approved maximum. Everyone wins: the injured person gets care, the provider gets paid fairly, and the insurer pays no more than it already approved. It’s a practical, good-faith solution.
Some insurers are now refusing even this compromise, insisting on applying the 2018 hourly rates rigidly. This isn’t just unreasonable, in our view, it is also legally unsupported.
FSRA Bulletin A-03/18 explicitly permits insurers to pay above the guideline rates for accidents occurring after April 14, 2018. The Guideline itself states: “Insurers are not prohibited from paying above the maximum hourly rates established in this Guideline.” These insurers have the authority to do the right thing. They are choosing not to.
The courts have noticed. In Malitskiy v. Unica Insurance, 2021 ONSC 4603, the Ontario Divisional Court upheld a Licence Appeal Tribunal (LAT) decision confirming that the effective hourly rate and its relationship to the Guideline amounts must be accounted for. An hourly rate that isn’t commensurate with the services provided is not compliant with the SABS and it can be challenged.
The Real Cost Falls on the Most Vulnerable
When insurers dig in on the 2018 rates, injured people are left with two impossible choices. The first is finding a professional willing to work below minimum wage, which isn’t going to happen, nor should it. The second is paying the difference out of pocket.
These are people who, in many cases, can no longer work at all. They are living on income supplements, without their regular paycheques, already carrying the enormous financial weight of their injuries. Forcing them to absorb the gap between fair market rates and an eight-year-old guideline isn’t just unfair, it’s a de facto denial of a benefit they are legally entitled to.
We Are Powerful in Numbers — It’s Time to Push Back
This isn’t just one injured person’s problem. This affects every accident victim in Ontario who needs attendant care. Every family member watching a loved one struggle to access services. Every PSW being undervalued. Every lawyer fighting these battles one file at a time.
Insurers are counting on people not knowing their rights, not pushing back, and the attendant care benefit effectively vanishing.
If you or someone you know is being denied fair attendant care benefits, speak up. Share this post. Talk to a personal injury lawyer. The more voices that challenge this practice, the harder it becomes for insurers to hide behind an outdated guideline.
Would you work for less than minimum wage? Then demand that no one else has to either.