OCF-19: Application for Determination of Catastrophic Impairment

The Financial Services Regulatory Authority of Ontario (FSRA) has a series of Auto Insurance Claims Forms (OCF Forms) that must be completed to apply for accident benefits after a motor vehicle accident through the Statutory Accident Benefits Schedule (SABS).

People who have been catastrophically impaired in a motor vehicle collision are entitled to higher amounts of accident benefits than people who sustained injuries of lower severity. To apply for the appropriate amount of accident benefits, catastrophically injured collision survivors must submit a completed OCF-19 form to their auto insurance provider.

Your attending physician will be required to complete the OCF-19 form. After assessing the severity of your medical condition, physicians can use this form to attest that your injuries meet the threshold for catastrophic impairment. Once your physician has completed this form, you can submit it to your auto insurer for increased coverage.

You can read more about the OCF-19 Form and download it on the FSRA website here.

What Information is Required on the OCF-19?

The OCF-19 must be filled out and submitted by an appropriate medical professional, such as a physician or neuropsychologist. It will need to include:

• Your personal and insurance claim details
• A detailed medical assessment
• Diagnosis and the reason why your injury has been determined as a catastrophic impairment
• Clinical findings and supporting documentation
• Confirmation that the injuries meet one or more of the specific criteria for catastrophic impairment under Ontario law

Injured claimants are also often required to submit supporting material proving the severity of the medical condition they sustained as a result of their auto accident. This supplementary material might include medical reports, statements from medical experts, and other documents supporting the accident victim’s claim.

What Benefits Might Be Available to Catastrophically Impaired Accident Survivors?

Receiving a catastrophic impairment designation can drastically increase the benefits you’re eligible for. All basic auto insurance plans in the province are required to provide policyholders with the minimum amount of coverage mandated by the SABS. The minimum amounts of accident benefits are as follows, and are determined by the severity of the injuries sustained:

• Minor Injuries: $3,500 for medical and rehabilitation benefits.
• Non-Minor, Non-Catastrophic Injuries: $65,000 for combined medical, rehabilitation, and attendant care benefits over 5 years.
• Catastrophic Injuries: $1 million for combined medical, rehabilitation, and attendant care benefits for life.

Some people may choose to purchase additional auto insurance coverage. They may be able to receive higher amounts of benefits than those included in basic auto insurance plans.

How is Catastrophic Impairment Determined?

Catastrophic impairments significantly impact an accident survivor’s overall quality of life. The word “catastrophic” is more than a way of describing a permanently injured person’s medical condition; it is a legal term subject to specific definitions.

Motor vehicle accident survivors may be entitled to additional accident benefits if they meet specific criteria, as per the provincial SABS. To meet the threshold for catastrophic impairment, survivors of collisions must have sustained at least one of the following conditions as a result of their automotive accident:

• Paraplegia or Tetraplegia
• Severe impairment of ambulatory mobility or use of an arm, or amputation
• Loss of vision in both eyes
• Traumatic Brain Injury meeting the Glasgow Outcome Scale-Extended (GOS-E) criteria
• Physical impairment or combination of physical impairments (which results in 55% or more of the whole person)
• Mental or behavioural impairment (excluding Traumatic Brain Injury) combined with a physical impairment (which results in 55% or more impairment of the whole person)
• Marked impairment in three or more areas of function that precludes useful functioning, or an extreme impairment in one or more areas of functioning due to a mental or behavioural disorder

Submitting an OCF-19 form to an insurance provider does not automatically qualify a claimant to receive additional accident benefits. Instead, the insurance provider will use the OCF-19 application to determine if the claimant’s injuries meet the threshold for catastrophic impairment.

How Can a Personal Injury Lawyer Help With the OCF-19?

Sometimes, insurance providers refute the opinion of the physician who filled out the OCF-19 on behalf of the injured accident victim. When this happens, they might deny the accident survivor’s benefits claim outright or offer them a settlement amount that is insufficient to meet their financial needs based on the injuries they sustained.

In these scenarios, receiving advice and guidance from an Ontario accident benefits lawyer can be crucial. If your insurance provider disputed your claim or has refused to pay you what you are rightfully owed, you should contact Preszler Injury Lawyers as soon as possible.

Our accident benefits lawyers serving Ontario have experience helping catastrophically injured survivors get the insurance coverage they are rightfully owed. To learn more about how our accident benefits lawyers may be able to assist you with the OCF-19 and your insurance claim, contact us today and schedule a free initial consultation.