One of the most important, most complex, and trickiest claim forms to complete following a car accident is the OCF-3 Disability Certificate.
Never heard of an OCF-3 Disability Certificate? That’s ok. Most people haven’t heard of any of these “OCF” claim forms until after they’ve been involved in a car accident.
There are many purposes to the form. But, the primary and general purpose of the form is to let the insurer know what injuries you’ve sustained as a result of the car accident.
The OCF-3 is completed by two people. The first half is completed by the accident victim themself, a family member, a lawyer, a friend, or a loved one. The first part of the form asks some very basic information which you ought to have no problems completing (provided that you can read and write in English). If English is NOT your first language, or you have problems reading and writing, then it’s best to get somebody else to complete the form on your behalf.
You will be asked for your name, date of birth, address, telephone number, and the date of the car accident. The trickiest part of the top part of the form is completing the section which asks you to describe how the car accident happened, along with the injuries you’ve sustained.
The insurer will look back to this section, and cross reference it with the medical and police records they’ve gathered throughout the litigation process. If there are any significant discrepancies, then beware.
Example: You say in this part of the form that the car accident was a t-bone collision and that the at fault driver also fled the accident scene. As a result of the t-bone collision, you’ve sustained a fractured skull, and 3 broken ribs. But the police records show that this accident was actually a rear end collision, and that you didn’t break any bones whatsoever. This will be a big red flag for the insurer, so be careful how you complete this part of the form. It’s best to consult a lawyer before submitting it to the insurance company. I have seen many a defence counsel refer and rely on these forms and accident/injury descriptions to hurt the credibility of injured accident victims, so don’t underestimate the importance of how you complete this part of the OCF-3 Disability Certificate.
The second part of the OCF-3 Disability Certificate cannot be completed by a lay person, or the accident victim. It needs to be completed by one of the following health care professionals:
– A Chiropractor – A Dentist – A Nurse Practitioner – An Occupational Therapist – An Optometrist – A Doctor – A Physiotherapist – A Psychologist – A Speech Language Pathologist
You yourself are NOT allowed to complete the second part of the form.
It asks many questions, which ask a variety of these health care professionals questions which I personally believe to be rather unfair. Why? These questions essentially ask the healthcare professionals to gaze in to a crystal ball and predict the future of the accident victim’s health.
How can you predict future health? I don’t know.
How can a doctor predict somebody’s future health for a patient they barely know, and just met? In many of these cases, busy hospital doctors who work in the ER or OR complete these forms. These doctors see thousands of patients per year. They won’t even recall their names or what they look like. In some cases, they can’t even speak to the patients because they’re unconscious. But, they’re still asked to complete these forms, which I’ve seen done rather poorly to the detriment of the accident victim.
Let’s examine some of the questions asked on the OCF-3 Disability Certificate shall we?
“Is the Applicant substantially unable to perform the essential tasks of his/her employment at the time of the accident as a result of and within 104 weeks of the accident” (if you understand that question, you must be a lawyer. Could they make that question any more complicated for a busy doctor?)
“Can the applicant return to work on modified hours and/or duties”
Both of these questions predispose that the doctor completing the form knows about the accident victim’s pre-accident job. In many cases, the doctor has never met the person before, and has very limited knowledge about what they do or don’t do for a living. That’s why it’s important to get somebody to complete the form who knows about your health history.
“Does the Applicant suffer a complete inability to carry on a normal life (i.e Has the Applicant sustained an impairment that continuously prevents the person from engaging in substantially all of the activities in which the person ordinarily engaged in before the accident)”
This question is so vague, that the form actually has to elaborate on the question with an “ie”. This is CLASSIC INSURANCE LAW. In order to answer this question properly, the health care professional completing this form (often a busy doctor), has to sit down with the accident victim and identify what their normal activities of normal life were BEFORE the car accident. Everyone’s definition of “normal life” is different. Some people are human dynamos and have all of the energy in the world. Others are lethargic. It all depends on the person. Not an easy question to answer. One which takes some thought and knowledge of the person.
“If you responded “YES” to any disability test above, what is the anticipated duration?”
This is one of my personal favourite questions because it asks the health care professional to essentially GUESS at when the accident victim will recover from their injuries. There are date ranges in this question, but it’s a loaded question to begin with. Insurance companies like to hold accident victims to these initial answers if they’re in their favour.
It’s always possible for accident victims to supply updated disability certificates to their insurer. This provides the insurer with a better picture of the claimant’s injuries and recovery. The insurer will PAY for having these OCF-3’s updated; but generally only when the insurer requests for an updated one. Providing one every week/month likely won’t be covered by any insurer.
If the OCF-3 Disability Certificate is not submitted to the insurer, no monetary benefits will flow to the injured party. Example: let’s say you’re in a coma in the hospital as a result of a catastrophic car accident and that you can no longer work. You would be entitled to an income replacement benefit of $400/week. If the Disability Certificate is not completed and submitted to the insurer, they’re under no obligation to pay out that income replacement benefit. So, if the doctors in the hospital don’t get to it, or don’t complete it properly, then you may have a problem recovering the benefits which you deserve in a timely manner. Believe it or not, things like that happen and they happen to all too frequently.
Finally; I’d like to discuss the economics of completing these Disability Certificates. As you can see from above, it takes time to complete the OCF-3 Disability Certificate properly. It takes thought, and knowledge of the patient along with their pre and post accident medical condition. Doctors bill through the OHIP System. They’re efficient at doing so. Time spent reading these forms, and completing them properly is time away from the bread and butter of their busy practices (or time away from helping other in need in a hospital setting). While doctors can certainly send the insurer a bill for completing the form, billing the insurer is more a hassle because it’s NOT THE NORM for said doctors. This is why getting a doctor to complete, or to take their time in completing the OCF-3 Disability Certificate can be problematic. Not impossible. Just slightly problematic depending on the doctor.
What happens when you don’t have a family doctor, a physiotherapist, an occupational therapist, a nurse practitioner, or a chiropractor to complete the form? Give us a call and we can help you out with that one. We will be able to put you in touch with a healthcare professional in your area to help you in this regard.
Enough law talk? Sure. Toronto’s basketball team is sorely missing it’s All-Star two guard Demar DeRozan. He was missed last night in the 4th quarter vs. King James and his cronies. I’m looking forward to his return so we can go on with our winning ways. Still, credit to Toronto. They fought hard and have been making it tough for their opposition despite playing without their All Star guard.
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