Anyone injured in a car accident is entitled to no-fault statutory accident benefits in Ontario, commonly referred to as SABS, through their automobile insurance policy. This means that even if you cause an accident, you are still entitled to SABS. If you do not have a car insurance policy, you are entitled to claim these benefits from the insurer of the vehicle in which you were a passenger, or the insurer of the vehicle that struck you if you were a pedestrian or cyclist.
What is the purpose of SABS?
Depending on the nature of your injuries, the purpose of the SABS is to provide you with access to benefits, such as income replacement benefits, and medical, rehabilitation and attendant care benefits, as well as several other expenses.
In the category of medical, rehabilitation and attendant care benefits, you will be placed within one of the below categories:
- MINOR-INJURY GUIDELINE – YOU WILL HAVE $3,500.00 OF AVAILABLE COVERAGE
- NON-CATASTROPHIC INJURY – YOU WILL HAVE $65,000.00 OF AVAILABLE COVERAGE
- CATASTROPHIC INJURY – YOU WILL HAVE $1,000,000 OF AVAILABLE COVERAGE
It is to be noted that depending upon the progression of your injuries and impairments, you may be moved from one category to another (i.e.: you may be placed in the minor injury guideline, and later moved into the non-catastrophic injury).
Overview of the essential forms to be completed
Upon notifying your insurer that you have been involved in a car accident, they will open a SABS file for you, and forward a package of documents to be completed – it is important to note your claim number as well as the contact information, including phone and email, for the claims adjuster assigned to your file.
The most important and time-sensitive of these documents to be completed are listed and explained in the chart below:
APPLICATION FOR ACCIDENT BENEFITS (OCF-1)
Who Completes The Form: YOU
This form must be completed as soon as practicably possible. This document provides the insurer with an overview of your background and injuries to allow them to make necessary determinations in the management and collection of your accident benefits.
EMPLOYERS CONFIRMATION FORM (OCF-2)
Who Completes The Form: YOUR EMPLOYER/YOU IF YOU ARE SELF-EMPLOYED.
This form is to be completed if you were employed at the time of the accident, and your injuries have affected your ability to work.
DISABILITY CERTIFICATE (OCF-3)
Who Completes The Form: YOUR DOCTOR OR TREATING MEDICAL PRACTITIONER
This form is to be completed by your doctor or treating medical professional. It provides the insurer with a summary of your accident-related injuries and impairments, as well as any pre-existing conditions that may affect your recovery.
PERMISSION TO DISCLOSE HEALTH INFORMATION (OCF-5)
The package sent by the insurance company will include an OCF-5 form. Do not sign and return this form to the insurer. Instead, your lawyers will provide the insurer with copies of all reasonable and relevant documentation.
EXPENSES CLAIM FORM (OCF-6)
Who Completes The Form: YOU OR YOUR LAWYERS
If you are paying out of pocket for expenses relating to your accident and injuries, please ensure you retain copies of all receipts where possible. Examples of expenses that may be covered, include but are not limited to: medications, assistive devices (such as a brace or crutches), parking, transportation costs, goods damaged in the accident, and visitor expenses. If in doubt, keep a copy of the receipt in your records, and forward these receipts to our attention at your convenience. We will provide you with advice on which expenses can be expected to be reimbursed. These expenses will be submitted to the auto insurer on an Expenses Claim Form (OCF-6).Please note that if you have extended health coverage (i.e.: health insurance privately, through your employer, or under your spouse’s policy), you will be required to first submit your expenses to the extended health coverage provider. Any expenses not covered by your extended health coverage provider will then be submitted to the auto insurer for consideration and reimbursement.
ELECTION OF BENEFITS (OCF-10)
Who Completes The Form: YOUR LAWYERS
If, at the time of the accident, you were working, caregiving attending school, retired and/or unemployed, you will be required to elect the weekly indemnity benefit most suitable to your circumstances. Please consult with your lawyers at Bogoroch & Associates LLP before completing this form.
TREATMENT AND ASSESSMENT PLAN (OCF-18)
Who Completes The Form: YOUR DOCTOR OR TREATING MEDICAL PROVIDER
To obtain treatment, your treatment provider must submit to the insurer a Treatment and Assessment Plan (OCF-18) via a platform called HCAI. Doing so allows your provider to submit their billing directly to the insurer, and allows the insurer to submit their reimbursement directly to the provider.If your provider does not submit this form to the insurer via HCAI, there is no guarantee that any expenses incurred by you with this provider will be reimbursed. Please ask your provider if they are equipped to submit their treatment via HCAI prior to commencing your treatment with them.
ASSESSMENT OF ATTENDANT CARE BENEFITS (FORM 1)
Who Completes The Form: REGISTERED NURSE OR OCCUPATIONAL THERAPIST
In the event that your injuries prevent you from being able to independently carry out your personal care needs, you may be eligible to receive the attendant care benefit. If so, please consult with your treatment providers and with your lawyers to coordinate an Assessment of Attendant Care Needs, which will be submitted to the insurer on the Form 1 document.
Examinations required by the insurer
To determine your entitlement to benefits or your continuing entitlement to benefits, including but not limited to, income replacement benefits, attendant care benefits and/or medical and rehabilitation benefits, please note that your auto insurer will arrange for you to be assessed by medical examiners of their choosing, but not more often than is reasonably required. If needed, the insurer will provide interpretation services as well as transportation services.
For more details, visit our Accident Benefits Form page.
Bogoroch & Associates LLP is experienced in all aspects of personal injury and medical malpractice litigation. We have the confidence and skill to advance your motor vehicle accident or medical malpractice claim to settlement or trial while helping you navigate the complex medical, legal, and insurance issues.
Our experience, commitment to excellence, and reputation have long been recognized. Our founding partner, Richard M. Bogoroch, has been recognized as a leading personal injury lawyer by The Canadian Legal Lexpert Directory and by The Best Lawyers in Canada. The Canadian Legal Lexpert Directory and The Best Lawyers in Canada are two highly regarded lawyer rating publications.
If you or your loved one has been injured in an accident or believes that you are a victim of malpractice or negligence, reach out to a personal injury or medical malpractice lawyer to understand if you too have a claim. Please contact any of our personal injury lawyers at Bogoroch & Associates LLP for a free consultation.