No-fault reform has been highlighted as a solution to a pressing problem in the context of Canadian medical malpractice claims: less than 1% of those harmed in the course of medical care receive any compensation for their injuries. Lee et al. (2021) suggest that a shift to a no-fault system is the answer for Canada's malpractice system. No-fault reform would certainly improve access to compensation but compensation is not the only reason to pursue a malpractice claim. Accountability and safety are important considerations that are not addressed by a move to a no-fault system.