For many Ontarians seriously injured in car crashes, the Attendant Care Benefit is a lifeline. It helps cover the cost of Personal Support Workers (PSWs) or family caregivers who provide daily assistance — bathing, feeding, dressing, and helping someone live safely at home.

But since the court’s decision in Malitskiy v. Unica Insurance Inc. (2021), many injured people are discovering that being approved for care no longer means being fully funded for it.

Insurance companies are using this ruling to justify paying only partial amounts — often less than half of what real care costs — leaving families scrambling to fill the gap.

What Malitskiy v. Unica Changed

In Malitskiy, the court ruled that an insurer’s obligation to pay attendant-care benefits is limited to the hourly rates listed on the Form 1 — the Assessment of Attendant Care Needs completed by an occupational therapist.

Those rates are:

• Level 1 — $14.90 per hour
• Level 2 — $14.00 per hour
• Level 3 — $21.11 per hour

However, those Form 1 figures were never intended to represent actual hourly pay rates.

They were created to calculate a monthly attendant-care benefit amount — a flexible sum that the injured person could use as needed to pay for care.

Even the Financial Services Regulatory Authority of Ontario (FSRA) has issued bulletins over the years reaffirming that the Form 1 rates are only a method of calculation, not a restriction on what insurers must pay per hour for required care.

Despite this, some insurers have begun treating those rates as fixed payment limits — ignoring the real cost of professional care and shifting the burden to families.

The Real-World Impact

On paper, insurers can say they’ve “approved” care.
In practice, they’re only paying a fraction of what’s required — and families are left to cover the rest.

A Young Family Holding It All Together

Imagine a young father who now lives with quadriplegia after a collision, was approved for 24-hour PSW care.

But his insurer only pays the Form 1 rates of $14 or $21 per hour, while his care agency charges $39–$42/hour for trained, insured workers.

That means only half his care is covered.

The rest — thousands of dollars every month — comes from his young family’s pocket.

His wife juggles work, parenting, and night-time caregiving — lifting, feeding, and repositioning him while their children sleep. When she can’t, his parents or friends step in.

The care is approved — just not affordable.

A Mother Who Can’t Rest

Imagine another family with an adult son with a severe brain injury. His insurer pays just $14/hour, the Level 2 Form 1 rate.

No PSW agency can staff at that rate, so his 68-year-old mother provides his care herself.

She sleeps on a couch outside his room because she’s afraid he’ll fall or wander during the night. She hasn’t had a full night’s sleep in years. Her body aches, her savings are gone, but there’s no other option.

This isn’t sustainable — it’s survival.

Why This Matters

This isn’t just a technicality — it’s about people’s lives.

When insurers treat the Form 1 rates as hard caps, they undermine the very purpose of the Attendant Care Benefit: to ensure seriously injured people can live safely, with dignity, and with the help they need.

• $14/hour doesn’t hire a PSW.
• $21/hour doesn’t sustain complex, 24-hour care.
• And no one should have to choose between recovery and financial ruin.

What Can Be Done

1. Talk to your lawyer and care team.

Ask whether your insurer is limiting your payments to Form 1 rates. Some care providers can continue through legal undertakings or deferred billing, but these rely on strong advocacy and trust.

2. Speak out.

If your care has been reduced or made unaffordable, your story matters.
Write to your MPP, contact the FSRA, or share your story with local or national media.

Ontario needs to hear how this interpretation is leaving families without essential care.

3. Support systemic change.

We’re calling on the FSRA and the Ontario government to:

• Update Form 1 rates to reflect today’s true cost of professional care.
• Re-affirm in writing that these rates are for calculation only, not payment limits.
• Hold insurers accountable for practices that undermine approved medical needs.

Why The Injury Advocates Is Speaking Out

At The Injury Advocates, we work alongside lawyers, healthcare professionals, and families who see these struggles every day.

The Attendant Care Benefit was never meant to fail the people it was designed to protect.

It’s time to bring fairness, compassion, and accountability back to the system.

Because when insurers only pay $14.00 – $21.11 an hour for care that costs double, it’s not just a legal issue — it’s a human crisis.

If your care has been reduced or paused because your insurer only pays Form 1 rates, please reach out.

You’re not alone, and together, we can make this issue impossible to ignore.