No one prepares themselves for an injury in a car accident. However, within your auto insurance policy, there are provisions in case injuries do happen. The Accident Benefits section of your policy provides compensation if you, one of your passengers or a pedestrian suffers an injury in a car accident. This is regardless of who was at-fault. Ontario’s legislation mandates that Accident Benefits are present in all auto insurance policies. This can help you pay for expenses you incur from your accident. But where do you start? Follow our simple guide on how to file an Accident Benefits claim below.
Before filing an Accident Benefits Claim
Even if you have the most experience as a driver, you are not immune to getting into an accident. You have an obligation to make a police report to the nearest collision centre within 24 hours—it’s the law! For a thorough explanation of how you should report a car accident in Ontario, click here.
Important: Do not try to move anyone who has an injury in the accident—you may aggravate them further.
Opening your Accident Benefits Claim
After reporting your accident to the police or collision centre, call your isure broker to begin the claims process. In the event of an after-hours emergency situation, our brokerage offers a 24-hour emergency claims service to assist you. Call our toll-free number at 1.877.51.isure (4-7873).
If applying for Accident Benefits, your insurer will assign a claims adjuster to handle your file. Guiding you through the claims process is what they do best. Adjusters handle your injury claim by:
- Taking your accident and injury details
- Checking the coverage list under your insurance policy
- Guiding you through the process of submitting your claim, including the explanation of any documents they require
- Giving a claim number for your reference
If you have injuries as a result of the accident, you will need to submit the forms within the Accident Benefits Application Package.
Firstly, if you want a quick and seamless process, fill out the applicable form clearly. Next, double check your work and make sure you sign and date the forms. And lastly, if anyone else fills in portions of the form (like your family physician), make sure they fill in their portion and submit as quickly as possible.
Sending in the forms
An Accident Benefits Application Package will include the following five forms:
- Application for Accident Benefits (OCF-1)
- Employer’s Confirmation of Income (OCF-2)
- Disability Certificate (OCF-3)
- Permission to Disclose Health Information (OCF-5)
- Treatment Confirmation Form (OCF-23)
Most minor claims do not require submission of all forms. Your AB adjuster can help you to determine which forms you need, depending on your unique situation. Once the insurance company has acquired these forms for review, your benefit eligibility will be given to you in writing. However, you can always contact your isure broker to help you through the process.
FYI: Within 30 days of receipt of the documents, return the completed documents and forms to the address in the document package you are given. Forms must be returned by regular mail, courier or personal delivery.
Having an assessment by your family doctor or nearby clinic soon after the accident is very important. If you were taken by ambulance to the hospital, ensure you request all tests and doctor’s notes be sent to your family doctor. If you seek treatment for your injuries, your treatment provider will ask for these documents in order to to assess you and design a treatment plan.
After assessing your injuries, your treatment provider determines which of the three categories of injury you are in. These categories help determine what amount of coverage you are entitled to. Remember, you have a number of treatment options available to help get you feeling better, sooner. It’s important to remember to choose a health care provider that is convenient to you, whether close to your work or home.
- Your primary health care provider or family doctor can recommend a specialist or therapist.
- Your AB claims advisor can provide you with the contact information of their providers for accident-related care.
Note: Your coverage by an extended health care plan has priority. This means that you must exhaust this coverage before submitting a benefit claim to your auto insurer.
Cost of your claim
In many cases, you can claim expenses in relation to your accident. If you lose, damage or have personal items destroyed as a result of your accident, you can claim them, as well. Expenses must also be seen as reasonable and/or necessary. They must meet your auto policy’s definition of “incurred.” Please talk to your isure broker, who can explain what an “incurred” expense is.
Disability Accident Benefits claims
If injuries from a car accident are serious enough to have you miss work or limit your daily activities, disability benefits are available. Your choice of benefits and the nature of your injuries will determine your coverage. There are several categories of disability benefits, ranging from income replacement to caregiver services. For a full list, click here.
Your AB claims advisor is knowledgeable and can explain which benefits apply to your injury and policy coverage. If you are eligible for more than one type of disability benefit, your advisor can explain the election process. If additional information or documents are needed, they can assist you with these, as well.
Payment of your claim
After reviewing all your forms, your isure broker will inform you in writing which benefits you’ll receive. Each month, an Explanation of Benefits Form detailing how your benefits are being spent is sent to you. However, if you’re not happy with the adjuster’s decision, call them for clarification. If you’re still not happy, you can dispute it.
Closing your Accident Benefits claim
If you are happy with your adjuster’s decision, you will receive the benefits that you qualify for and have your expenses paid out. Then, once all eligible benefits have been paid, your broker will close your claim and your file.
Accident Benefits: Critical timelines
To notify your insurer that you intend to apply for Accident Benefits.
To submit your Accident Benefits Application Package.
From the date of the accident to notify of intention to sue.
Most auto accidents are traumatic events. Even with seemingly-minor accidents, sometimes injuries don’t show up right away. Therefore, be sure to receive an assessment soon after your accident! If you require treatment, your auto policy has provisions built-in to help you. Speak to one of our isure representatives to help you better understand your coverage.