Motor vehicle accidents occur in a matter of seconds, but recovering from the debilitating injuries sustained in these accidents takes much more time. Fortunately, in Ontario, anyone injured in a motor vehicle accident (MVA) is entitled to certain accident benefits, even if they were at fault for the accident.
The amount and duration of these benefits vary depending on the severity of an accident victim’s injury. Insurers sometimes suggest that a person’s injuries do not qualify them for higher benefits. It is in your best interest to speak with an experienced accident benefits lawyer to ensure you receive the compensation you deserve and are owed for your injuries.
As you consider the path to recovery, remember that the personal injury lawyers at HSH are ready to show you that Hope Starts Here.
At A Glance
- Eligibility: Anyone involved in a motor vehicle accident in Ontario is eligible to claim accident benefits according to specified timelines.
- Statutory Accident Benefits Schedule (SABS): Provides funds for income replacement, medical and rehabilitation expenses, and other costs.
- Ontario Claim Forms (OCF): Must be requested and returned to the SABS insurer before certain deadlines.
- Legal Assistance: An HSH accident benefits lawyer can help you maximize your benefits.
How to Apply for Accident Benefits Following a Car Accident Injury in Ontario
Anyone injured in a car accident in Ontario is eligible to make a claim for accident benefits outlined in the Statutory Accident Benefits Schedule (SABS). This includes accident victims who are not covered by their own motor vehicle insurance policy or the policy of a family member, and accident victims who were partially or fully at fault for the accident.
Ontario established this element of its no-fault insurance system to ensure that all accident victims have access to financial resources for timely care.
To apply for SABS:
- Contact Your Insurer: First, contact your own motor vehicle accident insurer (or the motor vehicle accident insurer of a family member who lists you on their policy).
- Alternative Sources: If you don’t have access to MVA insurance from these sources, 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.
- Other Vehicles: If MVA insurance is unavailable from one of these sources, a person would contact the MVA insurer of any vehicle involved in the accident.
- Motor Vehicle Accident Claims Fund: If no MVA insurance is available from any other source, a person would apply for SABS from the Motor Vehicle Accident Claims Fund.
It is critical to observe certain timelines when applying for accident benefits. Unless your injuries are so severe that you cannot reasonably adhere to these timelines, you have:
- 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 the at-fault driver.
Once you contact the SABS insurer applicable to you, the insurance company 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.
The AB adjuster assigned to your claim will send a package containing Ontario Claim Forms (OCF). You will need to fill out and return these forms 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. Just be sure to remember that you must still contact the appropriate SABS insurer to begin the process even if you start filling out the downloaded forms.
What OCF Forms Do I Need to Complete?
Although many people are quite capable of completing OCF forms on their own, an incomplete form or one with incorrect information may delay your accident benefits payments. Moreover, choosing to apply for the wrong type of benefit at this stage could have serious consequences down the line.
HSH has prepared a helpful summary of which OCF forms need to be completed and tips for what information you should or should not provide to the SABS insurer. However, if you have specific questions about filling out these forms with respect to your personal circumstances, or if you believe you have been unfairly denied accident benefits, you can contact a member of our team for a no-cost, no-obligation initial consultation.
Key forms that you or the medical practitioner(s) treating you need to complete include:
- 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 to
- 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 – Employer’s Confirmation: The insurer will only pay for lost income if you remain off work for more than seven 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 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.).
- Lists what injuries you sustained; describes any restrictions you have regarding work, school, or housekeeping; and provides the medical practitioner’s expectation of the duration of your injury.
- Should be completed as soon as possible to ensure you can start therapy.I Insurers will not reimburse you for any therapeutic treatments that are not approved. The AB adjuster will provide this practitioner $200.00 for completing this form.
- 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: 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 your 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 your 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 can claim this benefit.
- OCF 23 – Treatment Confirmation Form: 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 if you sustained soft tissue injuries (sprains, strain, whiplash-associated disorder, contusion, abrasion, laceration, or subluxation, and any clinically associated sequelae).
- 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. Filing incomplete paperwork or missing an application deadline 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 you want to know more about 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.
A Reputation For Results
Our team has helped many people just like you or your loved one following a tragic motor vehicle accident. HSH is well known among insurers for our skill at building strong cases, negotiating fair settlements, and pursuing our clients’ interests at trial if we believe what they are offering you is unjust.
We not only get results for our clients, but we do it in a way that demonstrates our empathy, concern, and compassion for them and what they’re going through.
With an HSH accident benefits lawyer on your side and by your side as you rebuild following a life-altering accident, you can be confident that we will work tirelessly to help you get what you need and deserve to move forward.
To learn how we can help you on your road to recovery, contact us today.
