If you’ve been injured in a car or other motor vehicle accident, accessing the benefits your insurance entitles you to can be a complicated process. In Ontario, there are multiple forms that you’ll be required to fill out depending on the nature of the accident, beginning with the OCF-1, the Application for Accident Benefits.

This form needs to be completed when you’re applying for benefits from an insurer for the first time following an accident. It’s a vital piece of your insurance claim that plays into your ability to address your financial, medical, and rehabilitative needs post-accident.

Filling out the form can be an opaque and overwhelming process, especially at a time when you and your loved ones should be focusing on your recovery— but it doesn’t need to be. Here’s a breakdown of the application to guide you through this essential step.

The OCF-1 at a glance

The “OCF” in the form name stands for “Ontario Claim Form” and is a series of standardized forms intended for the processing of accident benefit claims.

As the first in the series, the OCF-1 is also arguably the most important, says Jeffrey Preszler, partner at Preszler Injury Lawyers. First, you need to fill out an OCF-1 form and send it to your insurance company to get any benefits. If you weren’t insured when the accident happened, the OCF-1 form specifies which insurance company you need to apply to.  In Ontario, no matter who caused the accident, automobile insurance providers are required to provide policyholders with mandatory benefits. These benefits are listed in the provincial Statutory Accident Benefits Schedule (SABS).

SABS applies not only to drivers involved in accidents but also to their passengers, pedestrians, motorcyclists, cyclists, and victims of hit-and-run incidents. If a pedestrian is injured in a motor vehicle accident, they can seek accident benefits through their own auto insurance policy, if they have one. If not, they can apply through the insurance of the vehicle involved in the accident or through the Motor Vehicle Accident Claims Fund if there is no insurance available.  Again, the OCF-1 form specifies which insurance company you would need to apply through.  Similarly, victims of hit-and-run accidents can also apply for accident benefits through their own insurance if they have such a policy, or through a vehicle for which they have regular access and use or the Motor Vehicle Accident Claims Fund if the identity of the driver cannot be determined. SABS provides coverage for medical expenses, rehabilitation costs, attendant care, and other expenses related to the injuries sustained in the accident, regardless of who was at fault.

You have seven days following your car accident to report it to the relevant insurer. From there, the insurer will send you a copy of the OCF-1. You can also download a blank, form-fillable version of the application here, via the Financial Services Regulatory Authority of Ontario, however, this form won’t have your claim number, or the contact information for the insurance adjuster overseeing your claim on it.

Under section 32(2) of the SABS, when a person is told they were in a car accident, their insurance company must provide them with the following:

  • The appropriate application forms
  • A written explanation of the benefits available
  • Information to assist the person in applying for benefits
  • Information on the election relating to income replacement benefits, non-earner and caregiver benefits, if applicable.

Once you’ve received your OCF-1 form, you have a short window of time to complete it— 30 days from the date of receipt, not 30 days from the date of your initial accident.

Types of Benefits

There are a number of non-OHIP related benefits available in Ontario that the OCF-1 is the gateway to, for example, income replacement benefits, non-earner benefits, visitor expenses, funeral expenses, death benefits, attendant care and medical and rehabilitation benefits to address your medical, dental, and even psychological needs. Even medications, prescription eyewear, and mobility devices are accessible through this one form provided an OCF-18 Treatment Plan is submitted for the insurance company’s approval.

Filling Out the Form

As per Jeffrey Preszler, do your best to be as truthful and honest as possible as you fill out the OCF-1. It can be tempting for anyone to inflate or exaggerate the effects of a motor vehicle accident when making a claim.  However, it’s crucial to not misrepresent yourself, the accident, or your losses because there can be severe penalties if you are found to have been misleading, in addition to having your claim denied outright. It’s better to aim to be as accurate as possible in your details, even down to the most minute information, because in situations like these where access to certain benefits are on the line, details matter.

If you find any of the details of the OCF-1 form confusing or hard to understand, Preszler recommends not signing it. You need to have complete appreciation for all your rights and responsibilities as the form outlines. Consider consulting with an accident benefits lawyer to help you complete the OCF-1.

What Happens if You’re Late

In addition to keeping the information you provide as accurate as possible, submitting the form in a timely manner is also a very important variable to consider. You’re given 30 days from the date you receive an OCF-1 from an insurance company to submit it. Failing to submit a completed form within that window of time could invite more scrutiny from the insurer when it comes to reviewing your claim or lead to an outright denial of your claim.   

The SABS does acknowledge that there are reasonable grounds for filing the OCF-1 late. Though it doesn’t go into detail about what those grounds may be, the Ontario Licence Appeal Tribunal has accepted many explanations as “reasonable” in the past, such as severe accident-related injuries and hospitalization, injuries that emerge much later, limited education or being relatively new to the province, among others.    However, best efforts should be made to notify your insurer within 7 days of the accident and submitting the OCF-1 within 30 days of receipt.

The Importance of Legal Representation

Having legal representation when dealing with the OCF-1 forms is crucial for ensuring that you receive the benefits you’re entitled to. These forms can be complex and confusing, and making mistakes or omissions could jeopardize your ability to access the benefits you need for medical treatment, rehabilitation, and income replacement. A knowledgeable personal injury lawyer can help you navigate the application process, ensure that all necessary information is provided accurately and on time, and advocate on your behalf with insurance companies. With legal representation, you can have peace of mind knowing that your rights are protected and that you’re getting the support you need during a challenging time.

This article was provided by Preszler Injury Lawyers. For more in-depth information, please visit their website at https://www.preszlerlaw.com




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