The Application for Accident Benefits, known as the OCF-1, is a form that Ontario victims of car accidents, truck accidents, motorcycle accidents, and pedestrian accidents use to obtain compensation. The OCF-1 allows accident victims to describe their accident and to indicate what types of benefits they are seeking under Ontario’s Statutory Accident Benefits Schedule (SABS).
Description of the OCF-1 Form
You must download and fill out the OCF-1 forms. The OCF-1 includes the following sections:
- Personal Information
- Insurance Information
- Details of Accident
- Other Insurance
- Your Signature
- Employer Information
- Income Information
- Additional Information
- Representative Information (if you have retained a lawyer)
- Insurer Information
Your insurer must fill out the “Insurer Information” section. You fill out the rest.
Background: Ontario’s No-Fault Traffic Accident Insurance
Ontario operates a no-fault insurance system for all kinds of traffic accidents. Under a no-fault system, the parties involved in an accident file claims with their respective insurance providers. Compensation is limited to pecuniary benefits such as:
- Medical expenses
- Rehabilitation expenses, if necessary.
- Income replacement if your injuries caused you to miss work.
- Attendant benefits—expenses for hiring a caregiver if you need one.
- Housekeeping benefits if you need to hire someone to keep the house while you are infirm.
- Death and funeral benefits if you are a dependent of someone who died in an accident.
These expenses could add up to more than you think.
Serious Accidents, Lawsuits, and Non-Pecuniary Damages
Ontario’s no-fault traffic accident system will compensate you for pecuniary benefits only. If your injuries meet a certain threshold, however, you can also file a lawsuit against the at-fault driver seeking:
- Future care costs if you suffered long-term injuries that require continuing medical care.
- Loss of competitive advantage if your injuries are long-term and you suffer from diminished earning capacity.
- Loss of enjoyment of life—inability to exercise or engage in hobbies, for example.
- Pain and suffering, including both physical pain and emotional distress.
The above benefits are only examples. You might also qualify for certain other non-pecuniary damages, such as disfigurement or loss of caregiving capacity. To qualify for these benefits, you will have to file a lawsuit against the at-fault driver. You will have to prove the following:
- Your injuries meet the threshold of “permanent serious impairment of an important physical, mental or psychological function.” These might include serious permanent injuries, chronic pain, and/or serious psychological injuries such as PTSD.
- The defendant driver was at fault for your injuries.
You can still claim pecuniary benefits from your no-fault insurance policy; it’s just that winning a lawsuit will also allow you to claim non-pecuniary damages. Winning a lawsuit can be a complex task requiring significant legal expertise. This complexity will also arise if you seek to win an out-of-court settlement against an at-fault driver. Most of the time, you have only two years from the date you knew or should have known of your claim to file a lawsuit.
Deadlines
You normally have seven days after your accident to notify your insurer of the accident. Of course, there may be an exception—you can’t exactly notify your insurance company while you are in a coma, for instance. The insurance company will then send you the OCF-1 form and any necessary supporting documents. Once you receive the documents, you then have 30 more days to submit your OCF-1 form to the insurance company.
Documentation
Your rule should be, ”When in doubt, document.” Keep a copy of your signed OCF-1 along with any other documentation that might be useful (your medical bills, for example). It’s better to submit too much than too little.
What Happens Next?
After you submit your OCF-1 to your insurance company, they will review it. They might accept your claim, reject it, or partially reject it. They might also ask for clarification of your claim or additional documentation.
Problems You Might Run Into
Following is an extremely abbreviated list of some of the complications that might arise:
- Coverage limits. No insurance policy will pay you more than the coverage limits of your policy.
- Insurance company bad faith. Your insurance company might arbitrarily deny your claim, impose burdensome documentation requirements, or otherwise deal with you in bad faith. In this case, you might be able to win a lawsuit against the insurance company for bad faith, which is a separate and independent claim.
- The insurance company challenges your medical expenses as unreasonable or unnecessary. This is especially likely if you use alternative treatments such as acupuncture.
No matter what problem you run into, you’re better off with a good lawyer than without one.
Your Claim Might Be Worth More Than You Imagine
You can probably handle a trivial claim on your own without an attorney. But is your claim really trivial? Non-pecuniary damages, such as pain and suffering, are difficult to quantify, so it is hard to know. Your best bet is to set up a consultation with an Ontario personal injury lawyer as soon as you can. Most personal injury lawyers only charge you attorney’s fees if they win your case.
At Findlay Personal Injury Lawyers, we work tirelessly to explore every avenue for compensation in your case, aiming to secure the best possible recovery. Reach out to us today at 905-522-9799 for a free consultation with an experienced personal injury lawyer.