Anyone injured in any way by a motor vehicle in Ontario must complete and submit an Application for Accident Benefits (OCF-1) in order to qualify for important insurance benefits.
If you have retained a trauma lawyer to assist you then the trauma lawyer should help complete the accident benefit forms on your behalf.
If you are doing the forms on your own here are 3 important tips:
Ontario is a no-fault system meaning that the detailed circumstances of the accident are irrelevant to your entitlement to accident benefits. You simply must confirm that you were injured in some way by a motor vehicle. The information you provide in Part 3 of the Application for Accident Benefits about how the accident occurred is later used by defence lawyers to contrast and contradict more detailed statements you may later make about the circumstances of the accident. Examples of what you should say include: “pedestrian hit by a vehicle” or “passenger in vehicle involved in a multi-car collision.” Do not get into the nuances of the accident as responsibility for the accident is not relevant to your benefit claim. Adding details can only serve to negatively impact your lawsuit later on.
The question in Part 3 of the Application for Accident Benefits about how the accident happened requests a description of the “cause and extent of the injuries” you sustained. The insurer wants this information to have a basic understanding of the severity of your injuries. But be aware that insurance companies often focus on what you list and don’t list as injuries arising from the accident. For example, someone with primarily orthopaedic injuries may list their orthopaedic injuries and neglect to reference their concussion. Later on a defence lawyer may argue that their failure to reference a ‘concussion’ suggests that they initially weren’t experiencing concussion symptoms. Instead, list your primary injury if there is one, like a fracture requiring surgery, or otherwise reference the Disability Certificate (Ocf-3) that your doctor or provider will complete on your behalf as that document must also be submitted to the insurer to open up your accident benefit claim. You may wish to write something like “leg fractures requiring surgery along with other injuries as set out in the OCF-3 to be submitted.” This kind of answer highlights the fact that you have more than whiplash (i.e. have injuries outside the Minor Injury Guideline) while at the same time referencing the Disability Certificate, which should ideally list all of your injuries.
If you have not sustained any fractures and believe you have suffered a concussion (head injury), then it is important to reference the concussion. The insurer will review your application to see if the injuries listed are injuries that fall within the Minor Injury Guideline (essentially whiplash) in an effort to determine whether your claim can be dealt with under the Minor Injury Guideline where only modest benefits are available. Your goal is to make sure that, where appropriate, your claim starts off in the non-catastrophic category rather than in the Minor Injury category so that you can access much more significant benefit limits to address your rehabilitation and care needs.
There is always an insurance company available to you to address your accident benefit entitlement. If you have your own car insurance then you should apply to your own car insurer. However, many people do not have direct access to their own car insurance and struggle identifying their appropriate accident benefit insurer.
Applying to the correct accident benefit insurer is important because the correct policy may provide enhanced coverage (like optional benefits or access to a family protection endorsement). If you are trying to squeeze into a policy with enhanced coverage it is important that you provide consistent information that would lead to coverage under the preferred policy. On the other hand, when you apply to the wrong insurer, that insurer will work to unearth information that confirms you ought to have applied to a different insurer. Insurers have a number of tools at their disposal to elicit information from you when they think that you may have applied to the wrong insurer, including requesting statements under oath, statutory declarations and documents regarding issues like dependency to figure out whether or not you qualify under a different policy. The insurer’s investigation into this issue will prove to be stressful, time consuming and will likely delay access to treatment. Because the priority sequence associated with applying to the correct insurer is complicated you should consider consulting with a trauma lawyer where appropriate for further direction in this regard.
While there are timelines associated with applying for accident benefits (such as an obligation to notify your car insurer within seven days of an accident and to apply for Accident Benefits within 30 days), failure to comply with those deadlines simply puts the insurer in a position to slow down your claim, but they do not get off the hook from their responsibilities.
At Thomson Rogers we pride ourselves on helping people through the very difficult period following a car accident.
If you have had a prolonged stay at a hospital following a car accident and would like a free no obligation consultation please contact the Trauma Lawyers at Thomson Rogers.
Darcy Merkur is a highly regarded Ontario trauma lawyer helping accident victims such as pedestrians, cyclists and motorists, who have sustained catastrophic injuries.
Darcy is one of just four plaintiff’s personal injury lawyers in Ontario recognized as a Certified Specialist in Civil Litigation by the Law Society of Ontario, listed in peer-reviewed publications – Lexpert®, The Best Lawyers™ in Canada and AV pre-eminent Martindale-Hubbell ®. He is also a partner at Thomson Rogers, one of Canada’s Top 10 Personal Injury Law Firms as selected by Canadian Lawyer Magazine.
Darcy can be reached at 416-868-3176 or by EMAIL.