Completing the Application for Accident Benefits is the single and most important step in any car accident case.
Without a completed Application for Accident Benefits, your car accident case; both for tort and accident benefits won’t get off the ground.
Failure to complete an Application for Accident Benefits can nullify your claim, no matter how legitimate that claim might be.
So where does one start? Good question!
After you’ve been involved in a serious car accident; or accident arising from the use or operation of a motor vehicle (motorcycle; bike/car; car/pedestrian; truck), you will first need to contact your own insurance company.
Sounds crazy right! Why on earth would you have to call your own insurance company to report a car accident that wasn’t even your fault.
But that’s how Ontario’s no fault system of accident benefits works. Regardless if the at fault driver was drunk driving, while texting and smoking cannabis all at the same time causing him to run a red light; you will still need to contact your own insurance company to make an accident benefit claim.
Your own insurance company is responsible for paying those accident benefits. It gets trickier if the injured party is a pedestrian, cyclist, or a passenger without insurance. It gets even tricker if none of the vehicles involved in the car accident didn’t have car insurance. That’s what insurance lawyers and personal injury lawyers are for. Sorting out those tricky and ever complex coverage disputes which insurers seem to love to argue over.
A good starting point to making that first call to your insurer is getting your pink slip of car insurance and contacting the claim number on the back of the form. There will be a policy number to refer to.
Large Ontario auto insurers generally have 24/7 claim centres to report an accident and start an accident benefit claim.
When on the phone, don’t just report that you’ve been hurt or injured in a car accident. Specifically mention that you wish to make an accident benefit claim and ask them to send you an Application for Accident Benefits. Some insurers will email you the Accident Benefit package right away; and send a follow up hard copy by regular mail.
The Accident Benefit Package will contain a plethora of complicated forms; most of which have the initials “OCF” along with a number next to them in the top right hard corner.
These OCF claim forms can be tricky and confusing. The insurer will also send you forms that you may not even need to fill out. They just whip off all of the forms in the Application for Accident Benefit in a standardized package with lengthy form letters. The only changes in the letters or packages are the claim and policy numbers, along with the contact information of the claimant and adjuster. Aside from that, they are all the same and contain standardized wording (which doesn’t make it any easier to understand).
The most important OCF claim form to complete is the OCF-1 Application for Accident Benefits. If you are unfamiliar with the OCF-1 Application for Accident Benefits, you can read an excellent past entry form the Toronto Personal Injury Lawyer Blog on how to complete the OCF-1 Application for Accident Benefits here.
If your insurance company hasn’t delivered you an OCF-1 Application for Accident Benefits, you can find the form on the Goldfinger Law Website, or click on the link here.
Another important form in the Application for Accident Benefits is the OCF-3 Disability Certificate. If you don’ know how to complete the OCF-3 Disability Certificate, you can check out a great past post from the Toronto Injury Lawyer Blog here entitled “Completing that complicated OCF-3 Disability Certificate”
The OCF-3 Disability Certificate is to be completed by a doctor or regulated health care professional. It’s a form which tells the insurance company what your injuries are in relation to the car accident, how severe those injuries are; and how long they estimate you will be able to heal from those injuries (if at all). It’s a rough synopsis of your injuries. If completed incorrectly, it can ruin a personal injury case. If a doctor who doesn’t believe that you’re injured, or who does not support your disability completes this form, it will likely have a negative impact on your personal injury case. If your doctor does not read the form correctly (which can happen), and ticks off some boxes in the negative which ought to have been ticked in the affirmative, it will also negatively impact your personal injury case as well. It’s a good idea to have a personal injury lawyer check out the OCF-3 Disability Certificate before it’s sent off to the insurance company to make sure that it’s completed properly and accurately.
Another important but often over looked form is the OCF-10 Election Form. With this form the injured accident victim can chose which benefit they wish to receive. For most people, you are essentially choosing between an income replacement benefit with a standard max of $400/week (it can be higher if you purchased optional benefits to increase this amount). Or you may select the non-earner benefit which pays up to $185/week (but for only 2 years). Electing which benefit is right for you depends on your pre-accident circumstances. It’s best to consult with a knowledgeable personal injury lawyer to discuss your options and what your best move might be. Sometimes the choices are obvious. Other times it can be hard to determine which benefit would be most advantageous to select.
The income replacement benefit and non earner benefit does NOT flow automatically. In order to qualify for these benefits, the injured accident victim will need to show compelling medical evidence that their injuries meet the tests for disability which both benefits are tied to. Regardless of what medical evidence is presented, an insurer has the right to have the claimant assessed by their choice of medical professionals by way if Insurance Examination (IE). These examinations are supposed to be independent, but in reality, they are far from that. When the insurance company chooses the assessors, pays their bill, and frames the questions which they want answered in a report they have requisitioned, how independent to you thing those reports will be….