In the event of an auto accident, you qualify for Ontario’s Statutory Accident Benefits. However, a fair benefits package depends, in part, on the accurate classification of your or your loved one’s injuries. This is especially crucial if you or your loved one suffered a catastrophic injury.
For example, the value of the Medical and Rehabilitation Benefit is based on the degree of injury, as follows:
- Catastrophic injury – may qualify for as much as $1 million in benefit payments.
- Non-minor injury – may qualify for as much as $50,000 in Medical and Rehabilitation Benefits.
- Minor injury – may qualify for as much as $3,500 in Medical and Rehabilitation Benefits.
Additionally, a victim whose injuries are classified as catastrophic may have access to extended and expanded:
- caregiver benefits;
- travel expenses;
- housekeeping and home maintenance benefits; and
- attendant care benefits.
You must submit an OCF-19 – Determination of Catastrophic Impairment with your or your injured loved one’s Application for Accident Benefits. An accurate form may increase your likelihood of a fair and timely benefits package. Below are four tips to assist you in this step of the claims process.
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Tip 1 – Determine if the injuries qualify as catastrophic.
The most common criteria that are submitted under an OCF-19 are as follows:
- spinal cord injury resulting in paraplegia or quadriplegia;
- amputation of arm or leg or injury causing complete impairment of a limb (applicable for accidents that occurred on or after September 1, 2010);
- loss of vision;
- traumatic brain injury with GCS of less than 9; or
- injuries that together comprise a significant disability (whole person impairment).
A car accident lawyer can offer guidance on how to work with your doctors to determine if your injuries qualify as catastrophic under the most current guidelines.
Tip 2 – Ensure the correct parties complete the form.
You are required to provide patient information for yourself or on behalf of a severely injured loved one. This includes details about the accident date, policy number and the applicant’s current medical status.
A physician is required to complete the majority of the OCF-19. Ideally, this should be a physician who has direct and recent knowledge of the applicant’s health, injuries and prognosis. A neuropsychologist or neurologist may complete the form in the event of a traumatic brain injury.
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Tip 3 – Complete and submit the forms in a timely manner.
Ask your insurance provider to provide you with deadlines for filing all applicable benefits forms. Note that the initial Application for Accident Benefits is due to the insurer within 30 days of initial receipt.
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Tip 4 – Seek help from a lawyer who understands Accident Benefits.
A lawyer is particularly valuable in cases involving catastrophic injuries. Ask your potential lawyer if he or she has experience handling car accident benefit claims involving injuries that are similar to your own. Call Preszler Law at 1-800-JUSTICE® to schedule a free, no-obligation case evaluation with a lawyer focused on motor vehicle accidents in Ontario.
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