In Ontario, if you are injured in an accident and need to access insurance benefits, the process begins by starting a personal injury claim, commonly referred to as an Accident Benefits claim. To do this, you need to fill out specific Ontario Claim Forms (OCF). In the context of personal injury law, OCF refers to the forms used for managing disputes related to automobile accidents and accident benefits.

OCF forms are governed by the Statutory Accident Benefits Schedule (SABS), which is a regulation under Ontario's Insurance Act. These forms are essential for initiating legal proceedings within the Ontario court system and ensuring that all relevant information is properly documented. They are used to document injuries and treatment and communicating with insurance companies throughout the claims process. Properly completing and submitting these forms is crucial for ensuring that accident victims receive the benefits and compensation they are entitled to under Ontario's insurance laws.

Commonly used OCF in personal injury law

OCF-1: Application for Accident Benefits

This form is used to apply for accident benefits under the Statutory Accident Benefits Schedule (SABS). It collects basic information about the insured person that is initiating the claim, details of the accident, details for which insurance policy(ies) may apply, and the injuries sustained.

OCF-2: Employer's Confirmation of Income

If you are claiming for a loss of income as the result of an accident, and wish to apply for Income Replacement Benefits, this form is used to obtain confirmation of your employment and income from your employer.

OCF-3: Disability Certificate

This form is completed by your healthcare provider to certify your injuries and provide details of your disability following the accident. It is essential for determining eligibility and entitlement to benefits.

OCF-5: Permission to Disclose Health Information

This form authorizes healthcare providers to disclose your medical information to your insurance company for the purpose of processing your claim.

OCF-6: Expenses Claim Form

If you have incurred expenses related to your injuries, such as out of pocket medical treatment or rehabilitation costs, prescriptions, assistive devices, or had to replace damaged items, you can use this form to claim reimbursement from your insurance company.

OCF-10: Election of Income Replacement, Non-Earner, or Caregiver Benefit

If you are eligible for multiple types of specified benefits, your insurer may request that you complete this election form which requires you to elect the benefit that best suits your circumstances. You would be asked to select which of the benefits you wish to apply for based on your circumstances and employment status, and this selection is irrevocable (cannot be changed). As stated, once an election is made, the answer is final, however, in the event that you are later found to have sustained a catastrophic impairment as a result of the accident, you may be given the opportunity to re-elect to receive a caregiver benefit, if you had otherwise not qualified for a caregiver benefit (as the caregiver benefit is an optional benefit). The insurance company may request this election, and, when requested, there is a specific time frame within which to complete and return the form.

OCF-18: Treatment and Assessment Plan

This form is used by your treatment provider to propose a treatment and assessment plan for your injuries. It outlines the treatment provider’s assessment of injuries, observations of the injured person in recovery, proposed treatment goals, providers, and costs. Each OCF-18 submitted by a treatment provider must be submitted for approval by your insurance company.

OCF-19: Application for Determination of Catastrophic Impairment

If you believe your injuries meet the criteria for catastrophic impairment under the SABS, an insured may submit this form to apply for a determination of catastrophic impairment. The OCF-19 itself would be completed by a treatment provider and submitted to the insurer for consideration.

OCF-21: Auto Insurance Standard Invoice

This form, completed by the treatment or healthcare provider, and submitted to the insurance company, is used to invoice the medical or rehabilitative goods and services, assessments and examinations or devices that have been provided.

OCF-23: Treatment Confirmation Form

This form is used to confirm the provision of treatment within the Minor Injury Guideline. Where the insured person has a valid insurance policy, treatment proposed on an OCF-23 form does not require prior insurer approval. This form is completed by your healthcare provider and submitted to your insurance company.

OCF-24: Minor Injury Treatment Discharge Report

This form is used to confirm to the insurer that the insured person has either been discharged from treatment within the Minor Injury Guideline (and no further intervention/treatment is required) OR, that the healthcare provider believes that the insured person will require treatment beyond that which can be provided within the Minor Injury Guideline, and indicates to the insurer that a further Treatment Plan (OCF-18) will be submitted by the treatment provider to the insurer, or that further treatment has been referred elsewhere. This form can also be submitted by a healthcare provider if the insured person has been non-compliant with treatment, was not attending for treatment, or has voluntarily withdrawn from treatment within the Minor Injury Guideline.

Navigating this system to start a claim can be overwhelming and complex under typical circumstances. Doing so while trying to recover from an accident can feel impossible. Seeking guidance from an experienced personal injury lawyer early on in the process can help you avoid undue stress and ensure that your rights are protected throughout your claim.

Interested in learning more about OCF Forms? Take a look at some of our other blogs below:

How to Start the Accident Benefits Process after an Accident Injury

5 Tips for Properly Filling Out an OCF-6 Form

OCF-3 Guide: What You Need to Know