Those Confusing Accident Benefit Forms: What You Need To Know

October 7th, 2018
Nivedita Misra
LLB, Lawyer
Sheena Sodhi
LLB, Lawyer

After reporting your injuries to your auto insurer, you will receive several letters and forms to complete. You don’t have to fill them in by yourself. Although completing them promptly is critical, it is to your advantage to have your lawyer help so they are filled in properly.

At Gosai Law, we understand that after being in a motor vehicle accident is stressful enough without having to, maneuver your way through a complicated accident benefits claim process. Our expertise lies in the very initial stages of completing your application to the possible resolution of your claim.

The process of completing and submitting the forms can be confusing, especially when you are in the midst of addressing your injuries immediately following an accident. Here are some of the most frequently asked questions relating to the forms, also commonly referred to as OCF forms.  

These are the key forms that are required to be completed as part of your accident benefits claim. There are others that our Accident Benefits team will help you complete.

I was injured in an accident. How do I start my claim?

An OCF-1 is an Application to Accident Benefits Form. It must be completed and signed by you in order to start your claim. Ideally, it should be submitted within 30 days of your accident to your auto insurer. In certain circumstances, if you are unable to submit this form within the 30 days you will be required to provide your insurer with a reason for the delay in submitting this form.

At Gosai Law, our staff will help you complete your OCF-1 Form.

As a result of my accident, I can’t return to work. What do I do?

An OCF-2 is an Employer’s Confirmation Form that is required to be submitted in order to seek Income Replacement Benefits (IRBs). This form must be completed and signed by you and your employer. Importantly, if you had more than one employer in the year prior to the accident you will be required to complete an OCF-2 for each employer.

At Gosai Law, our Accident Benefits Team will guide you through this process whether you were ‘Employed’ or ‘Self-Employed’ at the time of the accident.

My insurer is asking for a Disability Certificate. What is it? And why do I need it?

An OCF-3 is a Disability Certificate Form that outlines your injuries. This form must be completed by a health practitioner (such as a physician, physiotherapist, chiropractor, psychologist or any other licensed health practitioner) who assessed your injuries following the accident. This is an important form that must be completed and submitted promptly after the accident.

At Gosai Law, our team works diligently alongside your health practitioner to ensure that the form is completed in a timely and submitted to your auto insurer. Sometimes the auto insurer relies on the information when making critical decisions during your claim.   

This form is crucial in determining your entitlement to Income Replacement Benefits, Non-Earner Benefits or Caregiving Benefit. There is more about these benefits in this blog.

I do not have extended health benefits. Who pays for my out-of-pocket expenses?

An OCF-6 is an Expenses Claim Form, which is required to be completed if you have any reasonable and necessary accident-related expenses (e.g.such as prescriptions, over-the-counter medications, assistive devices, lost educational expenses, glasses, prostheses etc.), and so on that which are not covered under any other health plan. It is critical that you keep all bills and receipts for these expenses. At Gosai Law, our AB team will assist you in the completion and submission of this form.

I am unable to go back to work as a result of my injuries. Will my auto insurer assist me with income replacement during my time off work?

Yes. Your auto insurer will provide income assistance by way of Income Replacement Benefits (IRBs). Receiving this benefit is offset by any other disability or sick leave benefits available from other providers that you may have access to (like sick leave, short- or long-term disability or long-term disability, ODSP, CPPD or EI).

The OCF-10 is an Election of Income Replacement, Non-Earner, or Caregiver Benefit form. This is where you select the income benefit that applies to your circumstances. The accuracy in completing this form is critical as what you submit is considered final. Our AB Team will ensure that a thorough review is done of your employment history to determine what benefit is appropriate for you.  

Depending on whether you were employed or unemployed when you got hurt, our AB team will assist in determining the most suitable election of benefit depending upon your employment history.

How can I start receiving treatment? And what kind of treatments can I receive?

An OCF-18 is a Treatment and Assessment Plan form. This is completed by the health care practitioners you are seeing or the facility where you are being treated. After you are under the care of a treatment facility, you will complete this form following an injury assessment and submit a formal treatment plan to your insurer. It will be reviewed with you first. The form gives your auto insurer the opportunity to review the details of the plan proposed for you by your treating practitioner or facility.  

Based on your injuries, your treating facility will be able to submit OCF-18s for various types of treatments recommended by a practitioner. Here are the most commonly submitted treatments and assessments:

It is very important that you select a facility licensed as a Health Claims for Auto Insurance (HCAI) provider.  

Let Gosai Law Help You

Having a law firm represent you during this process is in your best interest. While you focus on recovering, we work to ensure continual access to treatment and benefits as made available through SABS.

If you have additional questions regarding AB Forms required as part of the processing of your claim, please use the Gosai Law resources and content library for more information. Our staff at Gosai Law is always willing to provide help and additional clarification.

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