Sustaining an injury in a motor vehicle, whether as a walking pedestrian, cyclist or passenger, can be overwhelming. You will likely need to apply for Accident Benefits through your insurance company to help you recover. Auto insurance claim forms, however, may seem quite intimidating at first glance, but we are here to help. In this article, we provide you with a brief overview of the five forms that make up an Accident Benefits package. In addition, we also touch on other injury-related claim forms that you may need during your recovery.
What is an Accident Benefits package?
As Ontario is a No-Fault Insurance province, everyone must apply to their own insurer for compensation, regardless of who is at-fault for the accident. If you are applying for Accident Benefits, your claims adjuster will initially send you the Accident Benefits package. These forms are the first important step of your claims process. It is important to note that the AB package has a deadline of 30-days from receipt to fill them in and return them to your insurance broker.
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)
1. Application for Accident Benefits (OCF-1)
The Application for Accident Benefits (OCF-1) is one of the most important claim forms. You should fill this application out soon after the accident. This form is the starting point for your claim for Accident Benefits. Without it, you will not be entitled to a number of benefits. The OCF-1 needs to be returned within the 30 days; if not, you will have to contact your isure broker and let them know why you are late. Otherwise, your may find that there will be a delay in receiving your benefits.
The following is a non-exhaustive list of some of the benefits that can be available to you when you fill out the OCF-1:
- Income replacement
- Medical rehabilitation
- Physiotherapy
- Chiropractic
- Massage
- Psychological
- Driver rehab
- Occupational therapy
- Attendant care
- Expenses
2. Employer’s Confirmation of Income (OCF-2)
Complete this form only if you are claiming Income Replacement Benefits (IRB). This applies if you were employed for at least 26 weeks in the year prior to the accident and are unable to return to work for more than a week. A delay in returning this form to your isure broker may delay the receiving or denial of your IRB request.
3. Disability Certificate Form (OCF-3)
The Disability Certificate (OCF-3) form is part of the proof you will provide to the insurance company that indicates you now have a disability as a result of the accident. You will need to complete a portion of this form, and a health practitioner, such as a physician or chiropractor, will fill out the rest. The insurance company relies on the answers to these questions in order to determine if you are eligible for weekly benefits. Your insurer will often turn to this form to help decide whether or not you should be entitled to ongoing benefits, and if the care you are receiving in therapy is beneficial to your recovery.
4. Permission to Disclose Health Information Form (OCF-5)
This form allows your insurance company complete access to your medical records from your family doctor, accessing hospital and clinical records, etc. Your adjuster uses these records to gauge how the treatments you are receiving are helping you in your recovery. These records are also used to monitor how your benefits are being allocated by your healthcare provider.
5. Pre-Approved Framework Treatment Confirmation Form (OCF-23)
The OCF-23 Treatment Confirmation form is a requirement once a healthcare facility determines that your injuries fall within the Minor Injury Guidelines. The Minor Injury Guideline (MIG) is one of the three categories of injury that you will be placed into during your assessment. When complete, it can be sent through the OCF-23 form to your insurer so that you can begin treatment right away.
Beyond the Accident Benefits package
Depending on the severity of your injuries as a result from your accident, you may need some additional assistance. Your assessment may conclude that you have non-MIG injuries, meaning your injury is more severe i.e. concussion or broken bone. This could also mean you may suffer from chronic pain or have an existing injury that is slowing your recovery. If you are unable to return to your activities of daily life (work, chores, care of dependents), you may need some extra financial or healthcare assistance. The following forms may be a requirement if you are experiencing more than minor injuries and require longer recovery time:
1. Treatment and Assessment Form (OCF-18)
This is a common form in your road to recovery, and is used to fund your proposed treatment. If you are engaging in treatment and would like to receive coverage from your insurer, then you must have this form filled out. It outlines assessments or examinations that a clinician or doctor feels are necessary in your recovery. Then, your claims adjuster will review the plan to approve or request clarifications.
Remember: If you have coverage from an extended health care plan, this coverage takes priority. Whether it is through your work, your spouse’s work or your parent’s coverage, it must be exhausted first before submitting a benefits claim to your auto insurer.
2. Application for Expenses Form (OCF-6)
This AB form is used to submit expenses you have as a result of your accident. These may include medications, prescriptions or transportation costs. Additionally, they can reimburse the cost to repair or replace lost or damaged items, like clothing, glasses, etc. You are required to keep original receipts for any claim expenses, and therefore, it is critical you keep all receipts.
3. Election of Income Replacement, Non-Earner or Caregiver Benefit Form (OCF-10)
If your injuries have left you unable to return to work right away, you may be wondering about whether income replacement options are available to you. Within the SABS, there are three possible benefits available:
- Income replacement benefits
- Non-earner benefits
- Caregiver benefits
The OCF-10 form can be of use when choosing from these three benefits. Selecting the most appropriate and beneficial one for your needs in the long run is important. While it’s possible you may qualify for multiple benefits, this form requires you to select only one type of benefit from among the three choices. Once you have made a decision on the benefit, you cannot change your decision later on.
Your road to recovery from your auto accident may be simple and straightforward. However, if you have sustained more serious injuries, it is important to speak with your insurance broker or claims adjuster to ensure that you understand your policy coverage. Your auto policy coverage is available to you after your extended health care coverage runs out. Your first step to recovery is completing and submitting the forms mentioned above in your Accident Benefits package. Speak with one of our isure representatives if you have any questions surrounding your AB coverage on your policy.
