OCF-1 APPLICATION FOR ACCIDENT BENEFITS
Start The Process
The Statutory Accident Benefits Schedule allows a claimant to access a wide variety of non-OHIP funded treatments, assessments, and medical devices, including:
- Medical and surgical services
- Dental services and devices
- Speech-language services
- Chiropractic and physiotherapy services
- Psychological services
- Occupational therapy services
- Prescription eyewear
- Hearing aid
- Wheelchairs and other mobility devices
While additional forms and paperwork will have to be filed to gain access to the various benefits, the OCF-1 Application is the gateway form to get the ball rolling.
There Are Two Parts To Your Claim: Accident Benefits And Tort
Most claims for motor vehicle accidents will have two parts to it. One part is your claim for Accident Benefits, which is your no-fault insurance No matter who is at fault for the accident, you could be entitled to these benefits. The other part to your claim is your law suit, also known as the Tort side of the claim, which is against the at-fault driver. The Accident Benefits part of your claim will often help provide you with immediate treatment and may provide you with income replacement and other benefits. That Accident Benefits part of your claim also should help build up the medical documentation in your file which will bolster the Tort part of the claim.
There are a number of different forms that you will need to discuss with your lawyer, and most of them will have to be filled out. Some of these forms include:
- OCF-2, Employer’s Confirmation Form
- OCF-3, Disability Certificate
- OCF-5, Permission to Disclose Health Information (Do not fill this one out without consulting with a lawyer)
- OCF-6, Expenses Claim Form
- OCF-10, Election of Income Replacement, Non-Earner or Caregiver Benefit
- OCF-18, Treatment and Assessment Plan
- OCF-23, Treatment Confirmation Form
Your insurance policy offers a number of different benefits, and without proper representation, the adjuster for the insurance company often conveniently (for them), leaves out certain benefits you may be entitled to. Your auto insurance company has an obligation to keep you fully informed of your benefits, and far too often, we see this is not the case. As listed above, you may be entitled to a number of benefits, including but not limited to attendant care benefits, treatment and rehabilitation benefits, non-earner benefits or income replacement benefits or caregiver benefits, and other benefits.
Many of these OCF forms, including the application form, will require your date of birth, claim number, time of the accident, date of the accident, policy number, and other additional information. Some forms require a health professional to add their opinion. Your employer will have to assist as well if you were working at the time of the accident and are claiming income replacement benefits.
Tell The Truth
The OCF-1 is considered your Applications for Accident Benefits and it is a crucial component of the package your insurer provides. It is important that this form is filled out correctly and honestly. It is possible that you could be punished under the Ontario’s Insurance Act for submitting misleading information. In other words, if you mislead or falsify information in an Application for Accident Benefits, you could be subjected to various penalties including an absolute denial of your claim or worse. You need not over-exaggerate your claim or provide a misrepresentation of your financial status and losses. Rather, provide information that reflects the truth to avoid landing yourself in a very precarious position against the insurer.
This form can be tedious and time-consuming—sometimes confusing. It is usually best that you fill out this form in the presence of a lawyer, so they can ensure it is filled out correctly. If you don’t understand the form, you certainly should not sign it. You only want to sign this form once you have a proper understanding of your rights. This is why we recommend you contact a personal injury lawyer with experience in Accident Benefits. These benefits can be extremely useful both to build up your claim and for the benefit of your health.
It is imperative to always tell the truth throughout the application process. Submitting false or misleading information in an application is a punishable offense and likely will cause more harm than good to your claim in the end.
Additionally, it is not necessary to exaggerate your injuries or overstate your losses. With that said, it is important to list all of your injuries, even the minor ones.
The Form Must Be Completed Properly
The OCF-1 Application for Accident Benefits is available through our website or you can visit the Financial Services Commission of Ontario, also known as FSCO, to download or print the form.
The beginning of the Application for Accident Benefits form, namely Part 1 and Part 2, are fairly simple to fill out. However, please exercise careful attention and ensure you put the correct information. At this stage, I typically don’t recommend to my clients sharing your email and fax numbers.
As you continue the application, Part 3 you will notice involves more thought. If there is information in this section that you don’t know the answer to, such as the police officer’s name, or the various doctors you saw, it is better to leave it blank than to take a wild guess. Additionally, it may be difficult for you to articulate exactly what your injuries are and the extent of them. It will be helpful to consult a lawyer for this section in particular, to ensure the right information is relayed to the insurer and in the most effective manner.
If you are filling out the form from your insurance company, and come across something you don’t understand, contact our office and we will be happy to provide you helpful information.
Filling out this form properly is a crucial part of ensuring your eligibility for the maximum number of available benefits. Consulting a personal injury lawyer can help ensure the process is as seamless as possible.
We Will Fight Your Accident Benefits’ Denials
At our law firm, we treat our client’s claim for Accident Benefits very seriously. If a client receives a denial on a particular application or treatment plan, we will do whatever it takes to get you the approval or find a different avenue to maintain your benefits if at all possible.
The way it works in general terms is your insurer will either approve or deny your various applications or partially approve them. For instance, your physiotherapist may submit an application for 12 physiotherapy sessions. This may be approved the first time around, but the insurer may eventually deny it pending what is called an Insurer Examination when they send you to one of their assessors. Far too often, these insurer examinations are biased, and your treatment plan comes back as not “reasonable and necessary”. This is when your lawyer should step in and either resolve the dispute with the insurer or bring it in front of the tribunal.
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