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Future care costs arising from motor vehicle collisions (“MVC”) are governed by a dual framework consisting of tort law and the Statutory Accident Benefits Schedule (“SABS”). While both systems purport to address the long-term care needs of injured plaintiffs, they operate according to fundamentally different principles and, in practice, produce vastly different outcomes. An examination of these two systems allows us to view the balance that is attempted to be made between the principle of tort law to restore the plaintiff to the position they would have been but-for the accident, and the cost-containment objectives embedded within the SABS system.

Future care costs refer to the ongoing expenses that will be reasonably incurred as a result of the injuries to an injured person due to increased care needs. Future care costs include long-term medical, rehabilitation, and attendant care needs. The leading Canadian authority on future care costs is Andrews v Grand & Toy Alberta Limited [1978] 2 SCR, where the Supreme Court establishes that the appropriate standard for future care costs in Canada is “full compensation”. The Court held that an injured plaintiff is entitled to recover the reasonable cost of future care insofar as money is considered. Courts have consistently held that future care is not limited to strictly medical interventions but extends to measures that allow for independent and dignified living. Home renovation and accommodation costs are a recognized component of future care awards where injuries affect a plaintiff’s mobility or ability to safely function within their residence.

From a tort perspective, future care costs constitute a well-established head of pecuniary damages aimed at restoring the plaintiff, insofar as money can do so, to the position they would have occupied but for the defendant’s actions/inactions. The assessment of true care costs in tort is inherently individualized, and evidence driven, as expert testimony from end-of-life care planners and medical professionals are used to determine what services are both reasonable and necessary in light of the plaintiff’s specific condition. These inquiries are not confined to what is strictly medically required, rather, it extends to measures that enhance the plaintiff’s independence and quality of life. As a result, tort awards for future care costs can be substantial, particularly in cases involving catastrophic injuries.

A plaintiff does not need to prove that they will incur future care costs or expenses with certainty, the standard reinforced in Graham v. Rourke is that the plaintiff must establish only a real and substantial risk of future expenses to be entitled to compensation.

Ontario jurisprudence demonstrates a steady expansion in the recognition and quantification of future care costs, particularly in catastrophic injury cases. Courts have approved large scale future care awards for attendant care, rehabilitation, home modifications, and lifelong medical support. These decisions reflect both the increased sophistication of life care planning and judicial recognition of the economic burden associated with catastrophic impairment. At the same time, the size of these awards highlights the widening gap between tort compensation and the comparatively limited benefits available under SABS.

Despite the broad compensatory approach taken in tort law, the primary purpose of SABS is to provide benefits coverage to anyone injured in a car accident, regardless of fault. SABS are characterized by standardized benefits, strict monetary caps, and significant insurer oversight.

SABS are divided into three categories, minor, catastrophic and non-catastrophic injuries. Minor injuries fall under the Minor Injury Guideline (MIG) and have a $3,500 treatment limit. Non-catastrophic injuries, SABs provide combined coverage of up to $65,000 for both medical rehabilitation and attendant care. Catastrophic impairments qualify for up to $1,000,000 in medical, rehabilitation, and attendance care benefits throughout the person’s lifetime. When comparing these values to the large amounts received in tort claims, it becomes clear that SABS are not intended to provide full compensation, rather, they function as a sort of social insurance model aimed at balancing access to benefits with systematic cost control. It is easy to imagine how quickly $65,000 can be spent over the course of two-three years if a plaintiff requires home renovation, attendant care, and medical treatment.

Catastrophic impairment is defined as an injury or combination of injuries so severe that it fundamentally alters a person’s ability to function, work, or live independently. Catastrophic injuries are the injuries that will bring about the largest amount of future care costs. When catastrophic injuries occur to young plaintiffs, future care costs can be in the millions of dollars, which would greatly exceed the SABS limit of $1,000,000.

In Marcoccia v Ford Credit Canada Limited, a twenty-year-old plaintiff was awarded nearly $14,000,000 in future care costs¹, and in MacNeil v Bryan, the 15-year-old plaintiff was awarded $15,158,500 in future care costs following a motor vehicle collision resulting in severe brain injuries, among others.² These two cases demonstrate that tort litigation often becomes the only realistic mechanism through which catastrophically injured plaintiffs can obtain compensation that more accurately reflects their actual long-term care needs.

More recently, in Waller v. Brown, the 52-year-old plaintiff suffered various physical injuries after being struck by a motor vehicle. The plaintiff’s housekeeping and home maintenance needs were assessed at $201,294.72 to age 75, subject to a 15% negative contingency. The Court also awarded significant future care costs totaling nearly $55,000, including occupational therapy, hydrotherapy, physiotherapy, psychology, medications, assistive devices, and case management services. These awards demonstrate how quickly future care claims can exceed the amounts available under SABS, particularly where plaintiffs require long-term treatment and rehabilitation. In this case alone, the plaintiff’s future care costs significantly exceeded the $65,000 available to non-catastrophic claimants under SABS.

The principles for awarding costs for future care to a plaintiff can be summarized as follows:

1. There must be medical justification for the claim.
2. The award must be fair and reasonable.
3. The claims must be reasonably necessary, having regard to personal circumstances.³

Recent Ontario jurisprudence continues to emphasize these principles, while maintaining that the burden of proof for future care costs lies on the plaintiff to show that there is a real and substantial possibility, or risk, of a particular pecuniary loss in the future to justify that cost.⁴ Future care costs should focus on the medical need for the individual rather than lifestyle considerations, and should not be awarded to include the costs to make the plaintiff’s life more tolerable or enjoyable.⁵

Common home renovation expenses include stair lift installation, which can cost up to $25,000, shower renovation to produce an accessible shower can cost up to $15,000, if kitchen counters need to be lowered

The interaction between tort law and SABS further complicates the compensation landscape in Ontario. While tort damages may compensate plaintiffs on a full compensation basis, plaintiffs are generally not entitled to double recovery. Accordingly, certain statutory accident benefits received under SABS may be deducted from tort awards relating to the same losses. This principle is illustrated in Morris v Prince, where $840,000 was deducted from the plaintiff’s $1,613,191.50 future care costs award as a set off for the accident benefit settlement. Nevertheless, the comparatively modest limits imposed under SABS often leave substantial uncompensated losses, particularly in catastrophic injury cases.

Ultimately, Ontario’s dual framework for future care costs reflects competing policy objectives. Tort law seeks to provide individualized and comprehensive compensation based on the plaintiff’s actual needs, while SABS prioritizes accessibility, predictability, and cost containment. Although both systems are intended to operate in a complementary manner, the significant disparity between multimillion-dollar tort awards and the comparatively limited SABS demonstrates that SABS alone are frequently insufficient to meet the lifelong needs of catastrophically injured plaintiffs.

While recent future care cost awards are generally larger than those awarded a decade ago, this increase largely reflects inflationary pressures and the rising cost of long-term care, rehabilitation, and attendant services. In contrast, SABS caps have remained stagnant since 2016, further widening the gap between SABS and the actual costs associated with catastrophic impairment. As a result, tort litigation has become increasingly important as the primary mechanism through which seriously injured plaintiffs may obtain compensation that more accurately reflects their long-term future care needs.

1. Marcoccia v. Ford Credit Canada Ltd., 2009 ONCA 317.
2. Severe Head Injury Claims, Tomlinson, 2016.
3. Rathan et al v Scheufler et al, 2023 ONSC at 315.
4. Ibid at 316.
5. Ibid.