Statutory Accident Benefits (“accident benefits”) are available to those who are injured as a result of the “use or operation of a motor vehicle”. This includes passengers, drivers, cyclists, or those who are injured by motor vehicles as pedestrians. Accident benefits are available regardless of fault and are therefore often referred to as “no-fault” benefits.
Below is an overview of the most common Auto Insurance Claims Forms (“OCF Forms”) that automobile insurance companies require an injured person to complete in order to consider and adjust a claim for accident benefits. Copies of these forms are available to the public and can be obtained online.
While these forms must be completed accurately, they are often difficult to understand. Many are to be completed by the injured person, however, others are to be completed by healthcare providers or employers.
OCF-1 Application for Accident Benefits
Completion of the OCF-1 form begins the process for claiming accident benefits. It is mandatory and should be completed by anyone who is injured as a result of the use or operation of a motor vehicle. Whether someone has been injured as a result of the use or operation of a motor vehicle is not always clear. If you are unsure, it is best to seek advice from a personal injury lawyer.
OCF-2 Employer’s Confirmation Form
The OCF-2 form must be completed in order to claim income replacement benefits. A portion of the form must be completed by the employer(s) of the injured person for the 4 or 52 weeks prior to the accident. Where the applicant is self-employed, he or she may complete this form in its entirety.
OCF-3 Disability Certificate
The OCF-3 form must be completed by a healthcare provider. A list of the providers who may complete the OCF-3 can be found on the form itself. There is space in the OCF-3 form for the chosen health care provider to identify the applicant’s accident related injuries, limitations, and a prognosis for recovery, among other things. Insurers may request that this form be completed multiple times over the course of an accident benefits claim.
OCF-5 Permission to Disclose Health Information
The OCF-5 form allows the automobile insurance company complete access to all medical records from any health care provider or hospital. A personal injury lawyer can advise as to whether an applicant should sign the OCF-5. Often, a lawyer will ask the insurance adjuster which medical records are required and then request and provide to the insurer what is relevant. Typically, an insurer may only go back one year prior to the accident date.
OCF-6 Expenses Claim Form
The OCF-6 form is used to submit expenses incurred as a result of an accident, such as prescriptions, ambulance charges, attendant care costs, and parking receipts for accident related treatment. It is critical that applicants save receipts and invoices for such expenses to provide to the automobile insurer along with the OCF-6 form.
OCF-10 Election of Income Replacement Non-Earner or Caregiver Benefits
The OCF-10 allows an applicant to advise the insurer which of income replacement, non-earner, or caregiver benefits he or she intends to claim. While an injured person may qualify for more than one of the three benefits, an election must be made. A personal injury lawyer can help with the appropriate selection.
OCF-18 Treatment and Assessment Plan
The OCF-18 form should be completed by a healthcare provider or facility to request approval for treatment for accident-related injuries. If an applicant is participating in treatment and wishes for it to be covered by the automobile insurer, then he or she should have an OCF-18 form completed for consideration and approval.
OCF-19 Application for Determination of Catastrophic Impairment
The OCF-19 form is to be completed by a healthcare provider if an injured person wishes to apply for a catastrophic impairment designation, which allows for access to increased automobile insurance benefits. The automobile insurance company must officially designate an injured person as catastrophically impaired in order to recover these enhanced benefits.
Seeking legal advice
The forms that will need to be completed and the timing within which they should be completed varies, depending on the situation. It is critical that they are completed properly and accurately. These forms become part of an injured person’s accident benefits claim, and the adjuster and defense lawyers will have access to all or most of this file.
Originally published 15 APR 2020