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Accident Benefits Application Forms

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Accident Benefits Application Forms

Don’t delay discussing your matter with us to find out how to build a winning case.

Please enable JavaScript in your browser to complete this form.

You don’t pay us unless we win your case. No Out of pocket expenses required.

Note: Your Privacy is Safe with us. We will never disclose your information to external parties.

After an accident, there are many things you need to do on a very specific timeline. In particular, there are several forms that need to be completed quickly. Ideally, you will work with a personal injury lawyer who can consult with you and help you complete these forms to maximize your settlement. Still, it’s a good idea to have a strong understanding of which forms you’ll need to complete in advance.

As you submit these forms, always make sure you make a copy of the form and any materials you must submit along with it. Keep the copies in a safe place in case you need them again.

Below, you’ll learn more about the key accident benefits application forms you may need to complete.

Application for Accident Benefits (OCF-1)

This is the basic and primary form you will need to complete after your accident. You will receive a package with the Application for Accident Benefits form in the mail which you must complete within 30 days of receipt. If you cannot complete it within 30 days, you should still submit the completed form to your insurance company along with an explanation of why you could not complete it on time.

Employer’s Confirmation of Income (OCF-2)

If you are claiming Income Replacement Benefits, you will need to complete the Employer’s Confirmation of Income form. You are eligible for these benefits if you were employed for a minimum of 26 weeks during the year before your accident occurred. You can only apply for these benefits if you cannot return to work for more than one week after the date of the accident.

Disability Certificate (OCF-3)

If you have become disabled because of your accident, the Disability Certificate is a crucial form to complete as it shows that a medical professional has diagnosed you with a disability. You must complete it with your doctor and any other health care practitioners you have seen. These may include chiropractors, occupational therapists, optometrists, speech language pathologists, psychologists, dentists, nurse practitioners, physiotherapists and others.

Permission to Disclose Health Information (OCF-5)

The Permission to Disclose Health Information is a form that you should only complete if the adjuster in charge of your claim requests it. This form allows the insurance company to review your personal medical records. Before agreeing to complete this form, make sure you find out which records the adjuster is requesting and why they are being requested. Also make a note on the form that you are only agreeing to allow the insurance company access to records for visits that occurred on specific dates.

Pre-approved Framework Treatment Confirmation Form (OCF-23)

The Pre-approved Framework Treatment Confirmation Form should also only be completed if requested by your insurance company. It is only for certain categories of injuries, so you do not need to worry about this form unless you hear from your insurer.

Election of Income Replacement, Non-Earner, or Caregiver Benefit (OCF-10)

It’s important to understand that while you may be eligible for both the Income Replacement Benefit and the Non-Earner Benefit and the Caregiver Benefit, you are only allowed to apply for and receive one of these. A lawyer can help you better understand which benefit you should apply for. You will need to submit this form within 30 days of the date you received it.

Application for Expenses (OCF-6)

The Application for Expenses is for any medical or personal expenses you incurred because of your accident. They may include medication, massage, physiotherapy, and other insurance-approved treatments. In addition, you can include babysitting or attendant care, housekeeping, transportation, and even any clothing or other personal items that were destroyed during the accident. It is imperative that you keep all receipts for these expenses, as they must be submitted along with the form. Make sure babysitters or other non-professionals create detailed receipts for their services so you are able to submit them.

Activities of Normal Life (OCF-12)

If your insurance company thinks you are entitled to attendant care, housekeeping, or non-earner benefits, they will request that you fill out the Activities of Normal Life form. In this form, you will describe any activities you could do prior to your accident that you can no longer do.

Declaration of Post-Accident Income and Benefits (OCF-13)

The Declaration of Post-Accident Income and Benefits form should be completed if you can work after your accident, but cannot work at your regular job or regular hours. It should also be completed if you are able to get disability benefits for your work. Completing this form will assist your insurer in determining your Income Replacement Benefit.

Application for Accident Benefits

If your insurance company will not pay a specific benefit you’ve applied for but you think you are eligible for it, you should complete an Application to the Safety, Licensing Appeals and Standards Tribunals Ontario (SLASTO). This form will initiate a mediation and potential hearing process.

Now that you have a clearer understanding of the forms you may be required to complete for your personal injury case, you will be more prepared throughout the process. Because it can be difficult to keep track of many forms and deadlines, it may be a good idea to contact a personal injury lawyer for assistance.

If you or a loved one has been injured in an accident, consult with an accident benefits lawyer as soon as possible to better understand your rights and maximize your claim.

Disclaimer: The content of this article is a general guideline made available for educational purposes only and is not intended to be used as legal advice for the reader’s specific situation nor in general. By reading our blog and website content, the reader acknowledges the above and understands there is no lawyer-client relationship created between you and Himelfarb Proszanski through this content. To get specific legal advice, we encourage you to book a free consultation with one of our lawyers to clarify the legal aspects of your situation.

Timing is Critical. Help is Free.

Don’t delay discussing your matter with us to find out how to build a winning case.

Please enable JavaScript in your browser to complete this form.

You don’t pay us unless we win your case. No Out of pocket expenses required.

Note: Your Privacy is Safe with us. We will never disclose your information to external parties.

Timing is Critical. Help is Free.

Don’t delay discussing your matter with us to find out how to build a winning case.

Please enable JavaScript in your browser to complete this form.

You don’t pay us unless we win your case. No Out of pocket expenses required.

Note: Your Privacy is Safe with us. We will never disclose your information to external parties.

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What They Say About Us

Sherene AlySherene Aly
16:02 23 Mar 24
I was very pleased with my decision to retain David and his team for my case. Melissa Gizzo was simply amazing and was able to secure a fair settlement for me.
T TT T
17:46 16 Feb 24
Experienced and excellent law firm. Their lawyers are wonderful, articulate, dilligent, amicable, calm, respectful, responsible, resourceful and have good human and customer relationships Especially DAN HOLLAND 👌 He is an amazing lawyer as regards dealing with any of the Accident case.I was involvedIn an accident in 2019 February. He was God sent as he dutifully and relentlessly worked hard until the case was settled
LizLiz
22:43 18 Jan 24
I highly recommend Dan Holland as a disability lawyer. His commitment to my case made the process seamless. Dan's clear communication and ability to simplify complex legal matters made it easy for me to understand every step. He demonstrated genuine concern for my best interests, making him not only a skilled attorney but also someone easy to talk to.Dan’s support extended beyond legal expertise; he alleviated my stress during the long-term disability case. His calm approach and unhurried demeanour ensured that there was no rush in our collaboration. This, coupled with his dedication, made the entire experience more manageable, fostering confidence in his ability to handle the case with meticulous care.I wholeheartedly endorse Dan for anyone seeking a lawyer who not only gets results but also prioritizes your peace of mind.
Neeshanth SritharanNeeshanth Sritharan
21:49 01 Jan 24
My mom was involved in an accident impacting her daily life and ability to work. Dan Holland has worked with us during the duration of our case and has been helpful in fighting for her and supporting us, and organizing the things we needed. Our family is incredibly grateful of the outcome Dan was able to obtain for us. I would highly recommend him!
Faiza HamidFaiza Hamid
01:26 22 Dec 23
I'm so happy I chose Mena Brar and her team represet us . We could not ask for a better team she is so kind, loyal, and honest. she spoke to me as an equal and made me feel as if my case was definitely important and that I deserved to be fairly compensated. I appreciate you. Did it for me and how this will help me get back on track with my life. keep helping others. You are doing amazing works, Mena Brar. I wish you all the best.
Brenda FurtadoBrenda Furtado
23:38 12 Dec 23
Many thanks to Silene Malhao for settling my husband's TORT claim and to Mena Brar for settling his accident benefits claim. These ladies made themselves available any time we had a question. They were very understanding and compassionate. We were completely taken care of throughout this process. We would definitely recommend this team to friends and family!
ShaunaShauna
15:52 06 Dec 23
We are so happy that we had David and his team represent us. We couldn't have asked for a better team. Not only is David incredibly skilled and experienced, he is kind and compassionate and it is clear how much he cares for his clients. Megan was also absolutely amazing to work with and was always on top of everything and there to answer any questions we had! Thank you!
Andrew CoutoAndrew Couto
23:10 21 Nov 23
I'm so happy I chose David as my lawyer. I spoke to a few lawyers before finding David and I noticed majority of them spoke to me in a way that felt demeaning or that my case wasn't big enough or important enough to take. One phone call with David and my opinion on lawyers changed. He spoke to me as an equal and made me feel as if my case was definitely important and that I deserved to be fairly compensated. The whole process was wonderful. From dealing with David's law clerk Ingrid whom is an amazing and kind woman to his legal assistant Melissa whom is another amazing kind and talented young woman. I was so stressed about this case but from day 1 they helped ease that stress and always answered all my questions promptly and respectfully. I couldn't believe David got me to mediation within 6 months of being cut off my LTD and got me a settlement way beyond my expectations. I can't say enough good things about this law firm but I guarantee you that if you need a lawyer to fight for you David is your guy! . Believe me when I say this is the law firm for anyone dealing with personal injuries especially LTD denial claims. Thank you so much to David, Ingrid and Melissa you truly don't know how much I appreciate all you did for me and how this will help me get back on track with my life. Keep helping others you guys are doing amazing work! I wish you all the best!
Rose RegazziRose Regazzi
21:15 11 Oct 23
I sustained a relatively painful injury, affecting me long term.I wouldn't otherwise had pursued it, as it involved a relatively large corporation, but felt it necessary to do so. However, many lawyers were daunted, with one, who actually referred me to HIMPRO.I was connected with Dan Holland, who reviewed the case, provided with me realistic expectations, sound advice and had a willingness to move forward and represent me.His calm and professional demeanor, brought me to a place of reassurance. His ease in addressing all facets of this process, clearly demonstrated a wealth of experience. There was never any hesitation, when being challenged, and felt my best interest was always in the forefront.This case has since been resolved, to my complete satisfaction.Without reservation, HIMPRO (and Dan Holland, in particular), would be the only firm I would recommend for these type of cases.
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HIMPRO is a leading law firm with full service personal injury and disability insurance lawyers. We have been recognized by Best Lawyers and assigned the highest rating, AV Preeminent, from Martindale-Hubbell. We provide a combined century of trial experience which has led to the successful settlement of over 10,000 cases with combined settlement value in excess of 3/4 billion dollars. Our mission is to win your case. At HIMPRO by Himelfarb Proszanski LLP we build winning cases. That’s the HIMPRO Advantage™.

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