OCF-19: Application for Determination of Catastrophic Impairment

In Ontario, anyone who is injured in a motor vehicle collision should be entitled to accident benefits. All auto insurance plans in the province are required to include the minimum amount of no-fault insurance coverage outlined in the Ontario Statutory Accident Benefits Schedule (SABS). That means any driver, passenger, motorcycle rider, pedestrian, cyclist, or other victim of motor vehicle collision should be entitled to accident benefits regardless of which party was responsible for causing the collision.

Accident benefits are intended to offset the costs incurred by injured victims of motor vehicle collisions. The amount of benefits available to each individual accident survivor is ascertained by determining the severity of their injuries.

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. In order 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.

Who Fills Out an OCF-19?

Physicians treating motor vehicle accident survivors are required to complete the OCF-19 form. After assessing the severity of the accident victim’s medical condition, physicians can use this form to attest that their patient’s injuries meet the threshold of catastrophic impairment. Once their physician has completed this form, the injured car accident survivor can submit it to their insurer.

Applying for accident benefits can be an involved and complicated process. Injured claimants are often required to submit supporting material proving the severity of the medical condition they sustained as the 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.

Submitting a thorough and accurate claim for accident benefits can be overwhelming, especially for people who have sustained permanent, catastrophic injuries that impact their abilities to perform routine activities. That is why it is so important to speak with an Ontario accident benefits lawyer before submitting a benefits claim to an insurance provider. Our accident benefits lawyers serving Ontario have experience helping catastrophically injured survivors of motor vehicle accidents get the insurance coverage they are rightfully owed.

To learn more about how our accident benefits lawyers may be able to assist you with your insurance claim, contact us today and schedule a free initial consultation.

What Benefits Might Be Available to Catastrophically Impaired Accident Survivors?

Insurance companies provide benefits payments to the survivors of automotive accidents based on their individual needs. More severely injured accident survivors are entitled to higher benefits payments than those who have sustained only minor injuries.

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. To learn more about your individual coverage, consult with your insurance broker.

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. In order 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 of 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 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 mental or behavioural disorder

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

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, contact Preszler Injury Lawyers today and receive a free initial consultation on your case.