'I Love You' - because my child might die?

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He had to leave. He was so ashamed about what he caused to happen to his sister. He couldn't just say sorry and work to gain her forgiveness because he just wasn't capable of that kind of communication or emotional input at that time. Whenever a crisis hit his instinct was always to run.
Steph was brave enough to reach out to him with that call, again something he would have been incapable of doing, though I suspect he missed her terribly. She finally breaks down his walls because what happened with the boy finally caused him to take stock of his life. She was there when he had need of her, just as he had picked her up when her life had fallen apart.
Clearly they are both v different people, but they complement each other perfectly, which is why it's so beautiful to watch.
I mean for a tough guy like that, who's never admitted a need for anyone, to be sobbing and all but begging her not to hang up or to leave him was the most gut wrenching thing I have seen on screen since Robin Williams told Matt Damon that "it's not your fault."

Friend with benefits? They BOTH give enormous benefits to each other. But Ali is the one to start the cycle in my opinion. Without Ali, Stephanie would never have been able to come back from her life-altering injury, feel alive again, feel human again. Ali *beep* her for god's sake. What a gift! Stephanie thought she would never make love again to another man, thought no guy would make love to a woman with her legs cutoff. Ali gave Steph her life back. She never would've come back to the marineland and face her orcas again without Ali. She would've killed herself if Ali hadn't left her his phone number. They're bonded forever. They cannot live without each other.

I know where you're coming from but there were a few indications to suggest otherwise. As has been said at the most desperate and crucial moments in his life he turns to her for emotional solace ( his son, his motivation to overcome odds during his fights and his strive to be a better man, reminiscent of As good as it gets

Also thought there were a lot of parallels in this and untouchables' both brilliant films imo, both almost adaptations of the buddy genre but very developed, with each character thriving and growing off the other (usually mentally /physically dependent on character) benefiting both.

One of these days I'm gonna get organezized

Stephanie was way more than a friend with benefits to Ali. He was visceral and alpha. Women were turned on by him and he didn't have any trouble finding female companionship.

The I love you because was his attempt to say:
I love you and the people I love in this world (my son, you, my sister) are in vulnerable situations right now. I am powerless to change their fates. I am powerless to make everything okay. I am terrible at understanding my feelings, much less how to express them to other people. But, I have to try.......so......here goes... I love you, I care about you, I want you in my life.

It was poignant, heart felt, and beautiful.

I thought when his son almost died it made him really think about what is truly important in his life and that he should fix his priorities. Almost losing him made him aware that he almost lost her too. Maybe it was cos he thought he would lose his son and he didn't want to be lonely, but maybe it just forced him to stop and think. He needed support and someone to lean on and he realised he found that in her; the person he loved.

I think this comment reflects your low aptitude for picking up on emotional queues throughout the whole movie. Don't take it the wrong way you probably make up for it with some other aptitude. For a lot of people this was perfect, the whole movie was a series of scenes that showed his path from mainly self centered and non-committing to "seeing the light" in regards to his responsibilities and loves.

I see you posted this almost one year ago, hope you don't mind me replying to it nonetheless.

I'm sorry you didn't see more like "friends with benefits" in Alain and Steph, cause there really was SO MUCH MORE.

Maybe you give the movie a second chance and try not to focus too much on the three words "I love you", but try to see the deep loving concern in his actions.

The day they get to know each other they meet only briefly. There is that incident in that night club and he brings her home - what in my eyes is the first sign that he feels attracted by her and cares about her right from the start.
Ali in the beginning is rough untouchable bitter character, he's someone who cannot wrap his emotions in words. So he isn't flirting with her in the common way, but he clearly shows concern by taking care she won't drive home alone, he wants her to be safe.

Later, after the accident, when she calls him, he finds her at home, without legs, her home and her whole life is a mess, she looks wrecked, ill and neglected, she mentions she stinks and needless to mention she doesn't appear attractive at all, neither visually nor emotionally.
Yet he stays, he never asks any questions, there is not one moment he judges her wasted look, he doesn't show any disturbed reaction to her loss of legs. He doesn't feel sorry for her (what can be one of the most awful reactions to a disabled person).
He instantly figures she is in urgent need of support and he doesn't hesitate a second to offer this support by taking her out of that *beep* she vegetates in and by taking her to the beach. He instantly pulls her out of her miserable state of total isolation and back into life.

At the beach he might appears a bit clumsy, but his actions are incredibly touching. He's not ashamed of her look at all, takes her on his shoulders, naked, and without legs, walks across the beach with all people looking at them and gives a flying *beep* what all those people think.

All these actions show so much more genuine love like a set of cheesy dialogues like we are used to see in other love stories. This movie - to me - is reflecting real life and real love in such a subtle beautiful way like never seen before in any flick.
Their silent interactions, the unconditional acceptance and how the two look at each other during the whole movie touched me deeply.

The scene on the phone you are talking about are only the final open commitment to what was clearly visible through the whole story.
The hard self-protecting shell of Alains character breaks and after all his massive emotional struggles with himself he's finally able to express in words what he feels.

Her call shows him he's worth it and there is someone who really loves him back in spite of all his flaws in the same unconditional way like he loves her.

Please consider to watch it again, as soon you take notice of all those subtle things I'm sure you will see something entirely different in this final scene.