Since the early 1990’s, all automobile policies in Ontario have included statutory accident benefits coverage. The accident benefits you are entitled to following a motor vehicle accident injury, even if the accident was your fault, include:
- Income replacement
- Non-earner benefit
- Caregiver benefit
- Housekeeping benefit
- Attendant care benefit
- Medical and rehabilitation expenses
Even with these rights, you still need to manage complex accident benefits claims to get the compensation and benefits you need and are owed to you from the Motor Vehicle Accident Claims Fund (MVACF). Accident victims understandably often have the impression the accident benefits process is simple, but usually it’s not.
Accident benefits: critical timelines
7 days
To notify your insurer of your intention to apply for accident benefits
30 days
To submit your Accident Benefits Application Package
120 days
From the date of the accident to notify of intention to sue
How to Apply for Accident Benefits Following a Car Accident Injury in Ontario?
If you sustain injuries from a car accident in Ontario, you are eligible to make an insurance claim for a variety of accident benefits that are part of Ontario’s Statutory Accident Benefits Schedule (SABS).
- First, contact your own MVA insurer (or the MVA insurer of a family member where you are listed on the policy)
- If you don’t have MVA insurance, a passenger would contact the MVA insurer of the vehicle they were in. A cyclist, pedestrian or other road user would apply to the MVA insurer of the vehicle that caused their injuries.
- If MVA insurance is unavailable from one of these sources, a person would contact the MVA insurer of any vehicle involved in the accident.
- If no MVA insurance is available from any other source, a person would apply for SABS from the Motor Vehicle Accident Claims Fund
You begin the claims process by contacting your car insurance company. They will take a claims report to assign you a Physical Damage Claims adjuster if your car was damaged. You will also be assigned an Accident Benefits adjuster (AB adjuster) for your injuries. You must notify your insurer of your intention to apply for benefits within seven (7) days of sustaining injuries in an accident unless your injuries are so severe that you cannot reasonably contact them within that time.
After you notify the insurer of your injuries, the AB adjuster assigned to your claim will send a package, containing Ontario Claim Forms (OCF). You will need to fill out and return to the insurer to receive the medical and rehab benefits.
If you want to start the process as quickly as possible, use the links below to access the appropriate forms. They are identical to the forms you will receive from the SABS insurer. Beginning the application process as soon as possible allows you to bring forms to medical appointments during the initial appointments and prevents delays in benefits – particularly income-replacement benefits.
Overview of Accident Benefits Ontario Claim Forms (OCF)
OCF 1 – Application for Accident Benefits. This form must be fully completed and returned to the insurer within 30 days, or the insurer will not need to pay you benefits.
The OCF 1 requires:
- personal information
- where and when the accident happened
- what police department and officer the claim was reported too
- your ability to work given your injuries, if applicable
- your employment income, if applicable
- your school enrollment, if applicable
- your responsibilities as a caregiver at the time of the accident
- other relevant information
OCF 2 – Employers Confirmation. The insurer will only pay for lost income if you remain off work for more than seven (7) days following the accident. Therefore, this form should be completed if you believe you will be unable to work/earn income for more than seven (7) days following an accident. Only complete this form if you are applying for income-replacement benefits.
The OCF 2:
- is partially completed by you and partially completed by your employer.
- may be completed by you and your former employer if you were not working on the date of your accident, but you had worked for at least 26 of the 52 weeks before the accident.
OCF 3 – Disability Certificate outlines the nature of your injuries and any debilitating conditions.
The OCF 3:
- is mostly completed by one of the health care professionals who are treating you (for example, a family doctor, physiotherapist, chiropractor, occupational therapist, psychologist, etc.).
- the AB adjuster will provide this practitioner $200.00 for completing this form.
- the health care professional will list what injuries you sustained on the OCF 3.
- describes any restrictions you have regarding work, school, or housekeeping.
- provides the health care professionals expectation of the duration of your injury.
- should be completed as soon as possible to ensure you can start therapy as insurers will not reimburse you for any therapeutic treatments that are not approved.
OCF 5 – Permission to Disclose Health Information must be completed to allow health care professionals to disclose your information to the insurer, and to permit your insurance company to request medical documents on your behalf.
OCF 6 – Expenses Claim Form is used to seek reimbursement of your out-of-pocket expenses (with itemized receipt/proof of purchase).
The SABS insurer will pay reasonable expenses including:
- damaged clothing or glasses.
- accident-related dental repair work.
- prescriptions (after you’ve claimed them through you extended health carrier, if applicable).
- over-the-counter medications or products used to treat your injuries (for example, heating pads, bandages).
- the ambulance bill.
OCF 10 – Election of Income Replacement, Non-Earner or Caregiver Benefit must be completed to receive any one of these benefits. It is very important to consider which benefit is the right one for you before you submit this form to the insurer. You will not be able to change your selection unless you are deemed to have catastrophic impairment (very severe injuries) later on.
- The Income Replacement Benefit provides 70% of gross income per week, to a maximum of $400 per week. An OCF 2 is also required.
- The Non-Earner Benefit provides $185 per week for up to two years (following a four-week qualifying deductible period). The test to qualify for this benefit is very high and only the very seriously injured would qualify.
- The Caregiver Benefit provides $250 per week plus $50 for each additional dependent child. Only people with policies that have the optional Caregiver Benefit included and are to claim this benefit.
The OCF 23 – Treatment Confirmation Form is completed by a treatment provider when they assess you and agree you need treatment.
This form could be completed by a:
- family doctor
- physiotherapist
- chiropractor
- occupational therapist
- and others
This form is predominantly completed when you sustained soft tissue injuries (sprains, strain, whiplash-associated disorder, contusion, abrasion, laceration or subluxation, and any clinically associated sequelae).
The OCF 18 – Treatment and Assessment Plan should be completed by a medical practitioner for any injuries beyond soft tissue damage. For example, fractures and concussions, would require an OCF 18. The OCF 18 should also be submitted if an applicant has a pre-existing medical condition that could/will delay their recovery.
We can help
Returning your completed OCF forms promptly and accurately should help ensure that the benefits you deserve are paid or reimbursed in a timely manner. Missing an application deadline or filing incomplete paperwork could result in an insurer delaying or denying approval.
If you have specific questions about these forms, if you believe an insurer has unfairly delayed or denied your application, or if want to know about all your legal rights and options following a motor vehicle accident, contact one of HSH LLP’s knowledgeable and experienced personal injury lawyers for a free, no obligation initial consultation.
We work hard for your rights
At Howie, Sacks & Henry , we use our expertise in accident benefits law to help you receive income replacement, caregiver, therapy, housekeeping, and attendant care benefits, and any home modifications you may be entitled to.
By vigorously protecting your rights against insurance companies before the courts and the Financial Services Commission of Ontario (FSCO), we can help relieve the stress and confusion that comes with navigating the no-fault benefit insurance system, and ensure you receive full compensation.
We genuinely care about our clients and are proud of our track record of maximizing their available accident benefits following motor vehicle accident injuries .
