Timely Filing of an Accident Benefits Application (OCF-1)
Unless they have suffered serious injuries, most people who have just been involved in a car accident are not immediately focused on their physical conditions. They might be concerned about fixing any damage caused to their vehicle, or they may be anticipating the bureaucratic headache of dealing with their insurance company.
Most people rarely consider the possibility that, sometime in the future, they might need treatment for injuries they have unknowigly sustained or that they may not be able to work — and earn an income — because of their injuries. Some car accident survivors avoid contacting their insurance companies altogether out of fear that their insurance premiums will go up if they do.
At Preszler Injury Lawyers, we receive calls every day from potential clients who tell us they were victims of a car accident months prior and do not know what to do. Some have suffered injuries and have even been unable to work for a few months. Some have not received any medical treatment because they simply cannot afford it and do not have any other options available to them. Often, when these potential clients are asked if they have notified their insurance company and commenced a claim for accident benefits, the answer is: “No.”
Regardless of fault for an accident, automobile insurance providers in Ontario are required to provide policyholders with mandatory benefits as outlined in the provincial Statutory Accident Benefits Schedule (SABS). Entitlement to each benefit is determined on a case-by-case basis and subject to the accident survivor’s ability to satisfy the required criteria. Our Ontario car acccident lawyers explore each client’s eligibility for all accident benefits that might be available and help eligible car accident survivors pursue them to ensure their recovery is as smooth as possible. That is why, if you have been involved in a motor vehicle accident, it is important to contact us for a free initial consultation as soon as possible.
In order to be eligible for any benefits, you must first file an Application for Accident Benefits (OCF-1) with your insurance company. If you do not have insurance at the time of your accident, you must apply through the insurance company of the driver of the vehicle you were occupying.
Section 32(5) of the SABS governs the timeline for filing a claim for accident benefits:
(5) The applicant (victim) shall submit a completed and signed application for benefits to the insurer within 30 days after receiving the application forms.
There is no specific consequence for failing to comply with section 32(2) of the SABS. However, section 55(1)(1) of the SABS indicates that an accident survivor may not be able to dispute the denial of benefits by the insurance company if they fail to file an OCF-1 within the time required. This means that the insurance company can continuously deny your claim for benefits and there is nothing you can do about it.
Even if you are not severely injured, it is essential to submit an OCF-1 at your earliest opportunity (even if the prescribed timeline has passed). Doing so could limit any opportunities for the accident benefits insurer to deny your claim and disqualify your entitlement to crucial benefits after your accident.
That said, even if the initial 30-day period mandated by the SABS has elapsed and your accident benefits have been summarily denied as a result, you may still be able to access the coverage you should be owed. In Ontario, the Licence Appeal Tribunal (LAT) is the forum in which disputes about entitlement to accident benefits can be argued. A recent case before the LAT illustrates how injured survivors of motor vehicle collisions may be able to recover accident benefits if their insurer fails to meet their obligations.
Case Summary: Nichols v. Gore Mutual Insurance Company
The recent decision in Nichols v. Gore Mutual Insurance Company involved a case where the victim, Heather Nichols (the “victim”), was denied access to accident benefits after being involved in a motor vehicle accident on May 24, 2018.
On the day of her accident, the victim appropriately informed her auto insurer, Gore Mutual (the “insurer”) of her involvement in an accident. The following day, May 25, 2018, the insurer sent the victim an introductory accident benefits letter informing her of her entitlement to benefits under the policy. In their letter, the insurer highlighted that the victim must complete the OCF-1 and return it to them within 30 days, otherwise her claim might be rejected.
On June 15, 2018, the insurer notified the victim that they had not yet received the OCF-1 and indicated that, if it was not received by July 18, 2018, her file would be closed. The insurer did not receive the OCF-1 by July 18, 2018; on September 11, 2018, the insurer wrote to the victim informing her that her file would be closed on September 28, 2018.
The victim hired a lawyer, who on July 23, 2019, contacted the insurer to inquire about her entitlement to benefits. The insurer indicated that they had not received the victim’s OCF-1 and as such, had closed her file months prior.
The victim finally submitted an OCF-1 to the insurer after a case conference before the LAT in 2022, over 4 years past the deadline prescribed by the insurer.
Was the OCF-1 Properly Provided to the Victim?
Pursuant to section 32(2) of the SABS, upon being informed of their involvement in an automobile accident, the insurer is required to give the victim 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.
In Nichols v. Gore Mutual Insurance Company, the lawyer for the victim insisted that the OCF-1 was not included in the initial letter sent by the insurer. Because of that, they argued that the insurance failed to comply with its obligation pursuant to section 32(2)(a) of the SABS.
In reply, the lawyer for the insurer stated that an accident benefits package consisting of an introductory letter and a blank OCF-1 form was physically placed in an envelope and sent to the victim, who was deemed to have received the package on the fifth business day after the document was mailed.
At the hearing, the insurer submitted the initial correspondence sent to the victim back on May 25, 2018 into evidence. However, they did not submit the OCF-1 that allegedly accompanied the letter, which raised questions for the adjudicator.
The adjudicator concluded that he was not satisfied that the OCF-1 was included with the letter dated May 25, 2018.
Decision at First Instance and Reconsideration
The adjudicator believed the insurer did their part by proactively following up with the victim regarding her failure to submit the OCF-1. The adjudicator did not find any evidence that the victim contacted the insurer to inquire further about the application process or any missing forms. The adjudicator found that the victim had a duty to mitigate this issue, but did not do so. Because of this, the adjudicator ruled in favour of the insurer and dismissed the victim’s application to dispute her denial of benefits.
The victim’s lawyer applied to have the decision reconsidered pursuant to Rule 18.2(b) of the Common Rules of Practice and Procedure.
The adjudicator reversed the decision made at first instance upon clarifying that the 30-day time limit set for filing an OCF-1 does not actually begin to run until the victim receives the OCF-1 from the insurer. Since there was no evidence that the victim ever received the OCF-1 from the insurer, the adjudicator concluded that the limitation period was not triggered. Therefore, the deadline could not have expired after 30-days elapsed.
This decision allowed the victim to file her OCF-1, even though the perceived deadline had elapsed years prior. The insurer was finally forced to assess her claim and her entitlement to benefits.
The SABS imposes a ticking clock on car accident survivors filing OCF-1 forms. They have a short, 30-day time limit to submit this form. But that ticking clock does not start running until the insurance company provides the victim with the requisite OCF-1 form. As this case demonstrates, if an insurer does not send an accident vicitm the correct form to complete and return within the mandated time limit, they cannot be beholden to the initial 30-day deadline.
It is important to complete all documents in a timely manner. Doing so can help avoid unnecessary and costly delays. Without immediate access to accident benefits, it can be difficult for injured car accident survivors to afford the treatment and time off work they might need.
However, even if your deadline has passed, you may still be able to get the accident benefits you deserve. Every case is unique, and our Ontario car accident lawyers offer a personalized approach to each individual client represented by our firm. To learn more about whether you might be entitled to accident benefits following your motor vehicle collision, call us today to receive a free initial consultation.
This article was written by Jordan Mintz.