Your car insurance company offers coverage if you sustain injuries in an auto accident. You may be eligible to file a personal injury claim as a part of Ontario’s Statutory Accident Benefits Schedule, or SABS.
Whether you are a driver, passenger, cyclist, pedestrian, or road user involved in an automobile accident, the nature of insurance coverage is that statutory accident benefits are offered to all victims involved.
Even if you do not have your own insurance, you may still be entitled to medical, rehabilitation, and income replacement benefits.
Life-altering impairments from a motor vehicle accident are unfortunately common. Herniated discs, broken bones, and traumatic brain injuries may often heal but the physical trauma can bring about a wide array of trouble. There are also the mental effects that come from a car accident. Anxiety, depression, and stress from financial hardships are all potential symptoms a person may face following a car accident.
As you engage your insurance company for accident benefits, an important step is to speak with an experienced disability benefits lawyer who can help you receive what you deserve in financial compensation and support.
Can You Get Disability Accident Benefits for Injuries After a Car Accident?
Injuries sustained after a car accident can qualify you for accident benefits, however, one must meet specific requirements.
For disability benefits, you will want to ensure you have the physical or mental impairments documented, that there is evidence that you are actively seeking rehabilitation, and that you are unable to engage in the work you performed in the past.
Always seek out prompt medical attention following a car accident. This provides documentation on the diagnosis, eventual treatment plan, and prognosis. The more medical evidence to support a disability benefits application, the better. A doctor’s letter can help to establish the need for income replacement benefits, medical and rehabilitation benefits, and benefits to cover reasonable and necessary expenses relating to living a normal life following a catastrophic injury.
Injuries That Qualify for Disability Benefits
There is not an exhaustive list of car accident injuries that qualify for disability benefits. However, it is not uncommon to see the following appear in a personal injury claim after a motor vehicle accident.
- Bone fractures in the leg or arm, healing and non-healing.
- Back disorders, such as lumbar spinal stenosis or vertebral compression.
- Spinal cord injuries.
- Severe burns that restrict functionality and limit the ability to perform everyday living tasks.
- Hip and neck injuries.
- Brain damage.
- Speech impairment relating to a traumatic brain injury.
- Vision or hearing loss.
- Non catastrophic injuries – i.e. ligaments, tendons, muscles, nerves, and blood vessels – resulting in a loss of function for a year or longer.
In addition to physical injuries, you may have cognitive issues or psychological trauma that can lead to depression or anxiety.
Notify Your Insurance Company About an Accident
In Ontario, it is required that you contact your car insurance company if you intend to apply for benefits within a maximum of seven (7) days after sustaining injuries in a car accident. The only exception to this rule is if the injuries sustained were so severe that there was no reasonable way for you to arrange contact.
After your insurance company is notified, an adjuster will then be assigned to your personal injury claim. They will send you a package of accident benefits forms known as Ontario Claim Forms (OCF). These need to be filled out and returned to the insurer to receive the benefits you are rightfully owed.
Complete the Accident Benefits Forms
The insurer must approve of you receiving the benefits you are applying for. The OCF forms are required to be filled out and submitted as soon as possible. When these forms first arrive, it’s easy to be overwhelmed by the sheer number and length of these forms. It’s key to remember that not all parts of OCF forms are designed to be completed by you. If you have any concerns about filling out these forms, please get in touch with us at Joshua Goldberg Law. We can help answer questions and ensure your rights are being fully protected as you enter in your information on these forms.
What can you expect to have to fill out for OCF forms to receive the Statutory Accident Benefits Schedule?
OCF-1
OCF-1 is the Application for Accident Benefits.
It is one of the most important OCF forms. If it’s not fully completed, the insurer does not need to pay you any benefits.
OCF-1 requires you to put in your personal information, outline where and when the accident happened, share if you are unable to work, define what your employment income is, share if you are attending school, and state whether you were responsible for looking after someone at the time of the accident.
OCF-2
OCF-2 is the Employers Confirmation.
If your injuries are so that you cannot work for longer than 7 days, the only way to recover salary or earnings in the long-term is from income replacement benefits.
The first part of this form is filled in by you. The second is completed by the employer. If you believe you will be back to work within 1 week, this document does not need to be filled in. The insurer does not need to know your personal financial information unless absolutely necessary.
Please note that if you were not employed on the date of your accident but worked for at least 26 of the 52 weeks period to the accident, you may still qualify for income replacement benefits. In this case, you would have your prior employer complete the OFC-2 form.
OCF-10
OFC-10 is the Election of Income Replacement Benefit, Non-Earner or Caregiver Benefit.
Non-earner benefits are for people who had not worked for more than 26 weeks in the 52 weeks prior to the accident.
This benefit has a four-week deductible period and then pays out $185 per week for a total of 100 weeks up to a maximum of $18,500. To receive this, you must demonstrate the inability to carry on a normal life due to injuries sustained in the accident.
Most people will not qualify for this benefit, however, if you believe you may, apply. After you submit your forms, you will not be able to go back and change your selection of what benefits you want to receive.
OCF-3
OCF-3 is the Disability Certificate.
The majority of this form is completed by a healthcare professional treating you, such as an occupational therapist, family doctor, physiotherapist, chiropractor, or psychologist.
OCF-3 is to list what injuries were sustained, what restrictions you are facing at work and in housekeeping, and the expectation for the duration of the injury. This form should be completed as soon as possible to ensure you can tap into these benefits to receive therapy and treatment.
To be reimbursed for them under your benefits, any and all therapeutic treatments must be approved.
OCF-5
OCF-5 is the Permission to Disclose Health Information.
This form allows healthcare professionals to disclose your private information to the insurer. It also permits the insurance company to request medical documentation on your behalf.
OCF-6
OCF-6 is the Expenses Claim Form.
This form is used to seek reimbursement for out-of-pocket expenses. Common expenses put in under OCF-6 include replacement of damaged clothing or glasses, accident-related dental repair work, prescription medications, and ambulance bills.
Any expense you list should be accompanied with an itemized receipt. An insurer will generally only pay a reasonable replacement cost and nothing further than that.
OCF-23
OCF-23 is the Treatment Confirmation Form.
It is completed by a treatment provider during the initial assessment period. This form is sent by a medical practitioner – such as a doctor, physiotherapist, chiropractor, or occupational therapist – to the insurance company.
OCF-18
OCF-18 is the Treatment and Assessment Plan.
If the injuries sustained in the automobile accident are beyond soft tissue damage, or if you have a pre-existing medical condition that is impacting how quickly you are able to recover, this form must be completed instead of the OCF-23.
What to Expect During the Claims Process
It is a fairly straightforward process when it comes to applying for accident benefits.
After you return the completed OCF forms, assuming they are accurate and correctly filled in, the benefits you are rightfully owed should be paid or reimbursed in a timely manner. Do not miss an application deadline or file incomplete paperwork. This will only delay or deny approval.
What to Do in Case of Denial
If your insurer denies your disability benefits, consider appealing with the help of legal counsel.
During an appeal, you may show that your original application didn’t include all your limitations or that your limitations were not properly considered as they relate to an income replacement benefit, lost education expenses, recovery compensation, and more.
A lawyer will work with you to go through your case and determine if it is strong enough to win an appeal.
Expert Legal Help
Applying for benefits can be stressful when you try to fill in all these forms and launch a claim on your own.
For expert legal help in how to apply for accident benefits in Ontario, reach out to our legal team at Joshua Goldberg Law. Receive support and guidance with your accident benefits, and ensure you aren’t denied what you are rightfully owed. One of our car accident lawyers in specializing in personal injury claims can help.
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