Not Sure If Auto Accident Treatments Are Covered by Insurance?

Understand what’s included under Ontario’s accident benefits and how to avoid paying out-of-pocket after a collision

If you've been injured in a car accident in Toronto or the GTA, your first concern—after safety—is often treatment. You want to recover quickly, but between navigating pain and paperwork, the process can feel confusing. One of the most common questions we hear is, “Will my treatment be covered?”

At Misir & Company, we regularly help people understand their rights, recover benefits, and coordinate care after an accident. Whether you’re dealing with whiplash, back pain, or post-concussion symptoms, knowing what treatments are available—and who pays for them—is critical.

Understanding Ontario’s Auto Accident Treatment System

In Ontario, treatment after a car accident generally falls under Statutory Accident Benefits (SABS), which are available to anyone injured in a motor vehicle accident—regardless of fault.

Covered Treatments May Include:

• Physiotherapy

• Chiropractic care

• Massage therapy

• Psychological counselling

• Assistive devices (e.g., braces, mobility aids)

• Occupational therapy

• In-home care or attendant support (if necessary)
  

However, just because a service is “eligible” doesn’t mean it’s always approved. Coverage often depends on:

• The severity of your injuries

• The type of injury and diagnosis

• The category your case falls into (Minor Injury Guideline vs. non-MIG)
  

We help you get these treatments approved, correctly submitted, and reimbursed—so you focus on healing, not paperwork.

How Timing Impacts Treatment and Recovery

Why Delays Make Things Worse

Some injuries—especially soft-tissue injuries like whiplash—don’t show symptoms immediately. You might feel “fine” the day after the accident, only to wake up with stiffness, headaches, or back spasms days later. But delaying treatment can reduce your recovery window and raise red flags with insurers.

Prompt treatment also helps ensure:

• A stronger case for benefits

• Less chance of chronic pain

• Better documentation of injury progression
  

At Misir & Company, we partner with providers to fast-track your initial assessment and build a treatment plan your insurer can’t ignore.

The Truth About Direct Billing Clinics

Many injured people avoid or delay treatment out of fear they’ll have to pay up front. That’s understandable—but not necessary.

What Is Direct Billing?

Direct billing means the treatment provider bills your insurance company directly—you don’t pay first and wait for reimbursement. But not all clinics are set up for this or familiar with the SABS process.

In our experience, the biggest frustrations come from clinics that don’t specialize in MVA (motor vehicle accident) injuries. We connect our clients with providers who understand the paperwork, timelines, and billing structure, so you avoid:

• Out-of-pocket costs

• Rejected invoices

• Delays in care
  

Whether you need physical therapy, pain management, or long-term rehabilitation, we ensure your treatment gets paid for—and started quickly.

What Type of Treatment Is Right for Your Injury?

No two auto injuries are the same. Some require immediate and intensive care, while others need gradual mobility rehab. Knowing which treatment fits your condition matters.

Common Post-Accident Injuries and Treatments:

Injury	Typical Treatment Approaches
Whiplash	Physiotherapy, chiropractic, stretching & mobility work
Back/Neck Pain	Massage therapy, heat/cold therapy, posture rehab
Concussions	Rest protocols, neuropsychological therapy, cognitive rehab
Soft-tissue injuries	Exercise therapy, TENS stimulation, myofascial release
Anxiety/Trauma	Psychotherapy, mindfulness-based stress reduction (MBSR)

We work closely with your care team to ensure that:

• You receive medically appropriate treatment

• Your insurer has all the required diagnostic evidence

• You aren’t sent to generic rehab clinics without MVA expertise

Navigating the Insurance Process After an Auto Injury

What You’ll Need to Do

1. Notify your insurer promptly You typically have 7 days to inform your provider of the accident.

2. Apply for Accident Benefits After you notify them, your insurer will send an OCF-1 (Application for Accident Benefits). This should be filled out and submitted within 30 days.

3. Get a Treatment and Assessment Plan (OCF-18) A licensed health provider must complete this plan and submit it for insurer approval.

4. Track approvals and billing Once your treatment plan is approved, sessions can begin—and should be direct billed whenever possible.
   

We guide you through each of these steps, help avoid paperwork mistakes, and stay on top of insurer response deadlines.

How Misir & Company Make Recovery Easier

You don’t have to do this alone. With us, you get more than legal advice—you get a coordinated recovery strategy:

• We review your case for treatment eligibility

• We help submit claims properly the first time

• We fight if your insurer denies or limits care

• We connect you with trusted providers across the GTA who specialize in accident-related injuries
  

Our legal team understands both the legal and medical side of recovery—and how to use each to support the other. If your injury leads to ongoing symptoms or lost income, we also help you pursue compensation for damages.

Frequently Asked Questions

Do I need a referral from a doctor to start treatment?

In most cases, a physiotherapy or chiropractor assessment can be done without a referral, but insurance may require it for certain treatments. We help ensure you get the documentation needed.

What happens if my insurance denies treatment?

We can appeal the decision, provide further medical justification, or request a review. Our legal support helps you avoid unfair denials or low coverage approvals.

Can I switch treatment providers if I’m not happy?

Yes. You are not locked in. If a provider isn’t giving you the care or administrative support you need, we help you switch to a trusted clinic that understands the MVA system.

Is there a time limit for how long I can receive treatment?

Coverage can last for months or even years, depending on injury severity. However, there are time-sensitive approvals and renewal requirements, which we monitor closely for every client.

Take the First Step Toward Recovery Today

After a car accident, you don’t just need treatment—you need a strategy. One that:

• Gets your recovery started fast

• Prevents you from paying out of pocket

• Keeps your insurance claims organized

• Gives you a clear path to getting your life back
  

At Misir & Company, we’ve helped hundreds of clients across Toronto access the care and compensation they deserve. If you’re unsure what to do next, start by talking to us.

Contact Misir & Company Today

Misir & Company Lawyers

880 St Clair Ave West

Toronto, ON, Canada

Phone: 416‑865‑6274

Email: info@misirandcompany.ca

Website: www.misirandcompany.ca