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Accident Benefits: Everything You Need to Know for Your Claim

by | Sep 22, 2021 | Personal Injury

Have you been involved in an accident? You are entitled to receive accident benefits from your insurance provider. This is often a complex process requiring lots of paperwork to be submitted in a timely manner. As much as it’s worth it to receive accident benefits and compensation, seeking assistance from a lawyer will be another great relief.

The last thing you want to worry about after being involved in an accident is dealing with paperwork for your accident benefits claim. It’s important to know that this is a complex process, with many different forms and procedures being requested by your insurance provider within a timely manner. Hiring a competent lawyer is extremely worthwhile since they will be able to liaise with your insurer as you take time to recover from your injuries and get back to your life.

If you’ve been injured in a car accident, learn everything you shouldn’t do when it comes to filing a personal injury claim.

Accident Benefits Explained

You may be asking – what are they, and do I have them? In Canada, the umbrella term ‘property and casualty insurance’ includes auto, home, business and disaster insurance. As such, you will be covered for accident benefits depending on your life situation – do you own a home, car, or do you rent? This will dictate the type of insurance you have and how accident benefits may be awarded.

A good example is auto insurance, as many people own a car. In Canada, car insurance is mandatory. The amount of coverage required varies between provinces, but the bottom line is that anyone who owns a car or other vehicle in Canada will be covered for accident benefits through their provider. Accident benefits will apply to a single vehicle accident as well as at-fault drivers. For those who were injured by a careless driver, a personal injury case may be pursued for more compensation.

An experienced lawyer can help you understand the best way to proceed depending on your unique accident benefits case. Remember that your lawyer is not the only one who must act quickly – you must know your responsibilities as well. In terms of an auto accident in Ontario, claims must be made rather swiftly – within seven days of the accident – to apply for benefits.

Accident Benefits Explained

What Do Accident Benefits Cover?

The compensation you will receive can include that of lost wages, medication and treatments, rehabilitation and even nursing or at-home care. Depending on your situation, the benefits may extend to housekeeping, childcare, pet care or any other relevant expenses you had to incur while recovering from your accident. These are often expensive services, and since they may be needed for an extended period as you recover, it’s important to know your rights for reimbursement. It’s debilitating to not be able to fulfill your work and at-home duties.

Remember that ‘recovery’ does not only mean that of a visible physical injury but may also relate to an internal ‘injury’. Examples can include a concussion or the development of another condition such as paranoia, fear or any other mental block that may have developed due to the accident that has negatively impacted your life.

These stipulations are listed by your insurance provider and may need some deciphering to understand the information necessary to proceed successfully with your claim. Despite how complex the paperwork and entire process may be, a seasoned lawyer will be able to help you with submitting accident benefits claim correctly, so you get all the support you need in a timely manner.

Paperwork Required in an Accident Benefits Claim

An active accident benefits claim can last for years, and clients remain involved in many aspects of the process. As things change and progress in your case, a lawyer will be able to anticipate what is needed to keep receiving the reimbursement you deserve.

Let’s look at the mandatory forms that make up the accident benefits application package in Ontario. These are the forms claimants and lawyers will come across throughout the accident benefits claim process.

Paperwork Required in an Accident Benefits Claim

OCF1 – Application for Accident Benefits

The first form that you will come across is the Application for Accident Benefits (OCF1). While an adjuster from your accident benefits insurer may open a claim for you immediately after an accident, this application still needs to be completed. To help make the process more manageable, your lawyer will fill it out on your behalf. It is then sent directly to the insurer, marking the start of your accidents claim.

OCF 2- Employer Confirmation

This form only needs to be filled out if you are claiming income replacement benefits, which you can do if you were employed before the accident but have stopped working due to injuries. For the most part, your employer will have to complete the form. Your lawyer will be there to assist you or your employer as needed.

OCF 3 – Disability Certificate

An accident benefits case will require a Disability Certificate. This form needs to be filled out by a treating physician or a qualified treatment provider. This sets out your injuries and indicates what activities you are disabled from doing. As explained earlier, you may be suffering from physical injury (i.e., broken bones) and/or internal injury (i.e., concussions, mental conditions) as a result of the accident. These need to be diagnosed by a healthcare professional.

Most clinics and physicians are experienced with accident benefits and will be familiar with the associated forms. An accident claims lawyer can answer any questions the healthcare professional may have about your specific case.

OCF 6 – Expense Claim Form

This form is used to record all expenses incurred as you recover from your accident. To make the process easy and stress-free, your lawyer will handle all the expense receipts and submit them to the insurer on your behalf.

OCF 9 – Explanation of Benefits

The OCF 9 is a form that insurance companies use to approve or deny any benefits claimed. They often contain an explanation regarding approval or denial and are exclusively sent out by the insurance company. This may result in frustration on the claimant’s side, especially if a treatment plan is denied. Your accident claims lawyer will be at your side to provide explanation and may even liaise or negotiate further with the insurance provider.

 OCF18 – Treatment Plans

Clinics or physicians fill this out with information to have treatments and assessments approved by your insurer. The form lays out the treatment requested and why the healthcare professional deems it reasonable based on their diagnosis. It also includes a quote, to which the insurer will respond using the OCF9 form.

Conclusion

As is plain to see, submitting an accidents benefits claim contains many moving parts. The claim does not close once the forms are submitted but rather, receipts, doctors’ notes and other information is added on, and the timeline will be unique for each case.

Personal injury due to an accident can be a traumatic and debilitating event both in terms of the physical injury sustained and the abrupt change it can have on your ability to live, work, and carry out everyday tasks. Let us help you regain control of your life by having our team of accident claim lawyers work alongside you. We will be there every step of the way.

Contact us at 416-943-6585 for a free, no obligation consultation so that you can see how we can work together and help with your accident benefits claim.

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