After a serious motor vehicle accident in Ontario, a finding of catastrophic impairment can significantly affect the accident benefits available to an injured person.
The OCF-19 (Application for Determination of Catastrophic Impairment) is the form used to ask an automobile insurer to determine whether an accident-related impairment meets Ontario’s legal definition of catastrophic impairment.
The distinction matters. For accidents occurring on or after June 3, 2019, the standard combined limit for medical, rehabilitation and attendant care benefits is generally $65,000 for a non-catastrophic impairment and $1 million for a catastrophic impairment, subject to the applicable policy and any optional coverage.
What is an OCF-19?
The OCF-19 is Ontario’s official Application for Determination of Catastrophic Impairment.
The current form is issued by the Financial Services Regulatory Authority of Ontario (FSRA). The present version, form AF-144, was updated July 1, 2026 and is used for accidents occurring on or after June 1, 2016.
Catastrophic impairment (CAT) is a specific legal designation under Ontario’s Statutory Accident Benefits Schedule (SABS). It does not simply mean that an injury is extremely serious.
The OCF-19 identifies the catastrophic impairment criterion or criteria believed to apply. These include specified spinal cord and mobility impairments, loss of vision, traumatic brain injuries, significant whole-person impairment and certain severe mental or behavioral impairments.
Some criteria have additional medical or timing requirements, so deciding whether and when to submit an OCF-19 can involve both medical and legal considerations.
For an overview of other forms used in Ontario accident benefit claims, see our guide to accident benefit applications.
Who completes an OCF-19?
The applicant or their substitute decision-maker completes the applicant portion of the OCF-19. The remainder of the form, including the medical assessment of catastrophic impairment, is generally completed by a physician.
If the impairment is a traumatic brain impairment only, the assessment may instead be conducted by a neuropsychologist.
The medical professional identifies the CAT criterion or criteria that they believe apply and provides information supporting that assessment.
There is not one universal waiting period for every OCF-19 application. Some catastrophic impairment criteria can be established earlier than others, while certain whole-person and mental or behavioural impairment criteria have additional timing or prognosis requirements.
The timing and applicable criterion can therefore be just as important as whether the person may qualify as catastrophically impaired.
What happens after the insurer receives an OCF-19?
Once an insurer receives an OCF-19 that has been prepared and signed in accordance with the SABS, it generally has 10 business days to respond.
The insurer must either:
- determine that the impairment is catastrophic; or
- determine that it is not catastrophic, give the medical and other reasons for that decision and advise the insured person if it requires an insurer examination relating to CAT status.
If an insurer examination is required, the determination process may continue after that assessment.
If the parties ultimately disagree about entitlement to statutory accident benefits, the dispute can be brought before Ontario’s Licence Appeal Tribunal – Automobile Accident Benefits Service (LAT-AABS).
How can an OCF-19 affect attendant care benefits while CAT status is being determined?
An OCF-19 can sometimes have an immediate effect on attendant care funding even before the insurer makes its final catastrophic impairment determination.
Under the current SABS, if:
- the application is made no more than 260 weeks after the accident; and
- immediately before the application, the injured person was receiving attendant care benefits,
the insurer must continue paying attendant care benefits while the CAT determination is pending. During that period, the amount is determined on the assumption that the person’s impairment is catastrophic.
Absent applicable optional benefits, the monthly attendant care limit is generally $3,000 for a non-catastrophic impairment and $6,000 for a catastrophic impairment.
For someone who requires extensive assistance with personal care and everyday activities after a serious accident, that difference can be significant.
HIMPRO recently dealt with these exact issues in a successful LAT case.
HIMPRO Case Result
Raman v. TD General Insurance Company: When an Insurer Treated an OCF-19 as Incomplete
HIMPRO Managing Partner David Himelfarb represented the applicant in Raman v. TD General Insurance Company, 2026 ONLAT 24-014730/AABS, a case involving a catastrophically impaired person whose enhanced attendant care benefits were delayed after TD received an OCF-19.The applicant had sustained severe injuries in a December 2023 motor vehicle accident. An occupational therapist assessed his attendant care needs at more than $13,000 per month, although the insurer was initially applying the $3,000 monthly non-catastrophic limit.
TD received an OCF-19 on October 3, 2024. It took the position that the form was incomplete because additional hospital records and a Glasgow Outcome Scale assessment had not been provided.
HIMPRO challenged TD’s position, and the Tribunal found that TD was not entitled to treat the OCF-19 as incomplete..
It found that the OCF-19 did not require the additional information TD said was missing in order to constitute a completed application. The Tribunal also found that TD failed to satisfy its obligations after receiving the OCF-19 and should have continued paying attendant care on the assumption that the enhanced catastrophic limit applied while its determination was outstanding.
What HIMPRO achieved for the client
| Issue | TD’s position / what occurred | Result achieved for the client |
|---|---|---|
| OCF-19 | TD treated the application as incomplete because additional medical information had not been supplied | The additional information TD demanded was not required for the OCF-19 to constitute a completed application |
| Attendant care limit | TD continued applying the $3,000/month non-CAT limit | The enhanced $6,000/month CAT limit should have applied during the relevant determination period |
| Delayed attendant care benefits | $9,591 in ACBs was delayed | Delay was unreasonable; 25% special award, plus applicable interest |
| Guardianship expenses | $41,670.13 in court-approved guardianship costs remained unpaid despite TD’s prior agreement to fund the application | Withholding/delay was unreasonable; 18% special award, plus applicable interest |
| Overall result | Total principal amounts found unreasonably delayed/withheld: $51,261.13 | Additional special awards on those amounts: at least $9,898.37 total, plus applicable interest |
TD continued applying the lower attendant care limit until March 2025. The Tribunal found that maintaining it for approximately six months constituted an unreasonable withholding or delay of $9,591 in enhanced attendant care benefits.
The Tribunal ultimately ordered a 25% special award in relation to those delayed attendant care benefits. It separately ordered an 18% special award relating to the $41,670.13 in guardianship expenses, together with applicable interest.
What can injured people learn from the Raman decision?
Raman shows the difference between an insurer asking for more information to assess catastrophic impairment and treating the OCF-19 itself as incomplete.
The Tribunal looked at what the form actually required and found that TD had not established a basis for treating the application as incomplete.
The decision also shows that an OCF-19 can affect benefits while the catastrophic impairment determination is still being made, rather than only after CAT status has ultimately been accepted.
If an insurer unreasonably withholds or delays payment, the LAT may consider a special award in addition to the benefits and interest owing. In Raman, TD had ultimately paid the delayed attendant care benefits before the final decision, but the Tribunal still made an award arising from the earlier unreasonable delay.
What if the insurer says an OCF-19 is incomplete?
An insurer may legitimately require additional medical information or an insurer examination as part of deciding whether a claimant meets the catastrophic impairment criteria.
Requesting more information does not necessarily mean the application itself was incomplete.
If an insurer says an OCF-19 is incomplete, relevant questions can include:
- Has the form itself been properly completed and signed?
- Has the appropriate medical professional identified the CAT criterion being relied upon?
- Is the insurer requesting additional evidence to assess CAT status, or claiming that the application has not yet triggered its statutory obligations?
- Is the insurer complying with the applicable response timelines?
- If the claimant was already receiving attendant care, are those benefits being paid at the appropriate level while the determination is pending?
In Raman, these issues had practical consequences for the benefits available to the injured person.
What if the insurer denies catastrophic impairment?
An insurer’s decision that CAT status has not been established can be disputed.
Its notice must provide the medical and other reasons for the decision and indicate whether the insurer requires an examination relating to the CAT determination.
Where the disagreement cannot be resolved, a claimant may dispute the insurer’s decision through the Licence Appeal Tribunal.
CAT disputes can involve issues such as whether:
- the correct catastrophic impairment criterion has been applied;
- the medical evidence satisfies the applicable test;
- physical and mental or behavioral impairments have been assessed appropriately;
- required timing and prognosis conditions have been satisfied;
- the insurer has complied with its procedural obligations; and
- benefits have been properly paid while the determination is pending.
Why does catastrophic impairment status matter?
A CAT designation can significantly increase the resources available to someone with severe and long-term accident-related needs.
For accidents occurring on or after June 3, 2019, the standard combined limit for medical, rehabilitation and attendant care benefits is generally $1 million for catastrophic impairments, compared with $65,000 for other non-minor impairments, unless applicable optional coverage changes those limits.
CAT status can therefore affect access to rehabilitation, attendant care, treatment and other supports over the course of a serious injury claim.
How can a catastrophic impairment lawyer help with an OCF-19?
Catastrophic impairment claims often involve medical evidence, statutory criteria, insurance forms, deadlines and insurer examinations.
A lawyer experienced in catastrophic impairment claims can help assess which CAT criteria may apply, review the medical evidence supporting an OCF-19, monitor the insurer’s response and identify benefits that should continue while the determination is pending.
A lawyer can also challenge an improper denial or delay and, where necessary, represent the injured person in a dispute before the Licence Appeal Tribunal.
In Raman, HIMPRO Managing Partner David Himelfarb represented the applicant and successfully established that TD had unreasonably delayed benefits following receipt of the OCF-19.
At HIMPRO, we build winning cases – FAST. That’s The HIMPRO Advantage™.
If you or a family member has suffered a serious injury in a motor vehicle accident, contact HIMPRO for a Free Consultation about an OCF-19 or catastrophic impairment determination.
OCF-19 Frequently Asked Questions
What does OCF-19 stand for?
OCF-19 is the Application for Determination of Catastrophic Impairment, the Ontario automobile insurance form used to apply for a CAT determination. The current FSRA form number is AF-144.
Does filing an OCF-19 automatically make someone catastrophically impaired?
No. The form asks the insurer to make a catastrophic impairment determination based on the applicable legal criteria and medical assessment. The insurer may accept CAT status or determine that the criteria have not been met.
How long does an insurer have to respond to an OCF-19?
The insurer generally has 10 business days after receiving an application prepared and signed in accordance with section 45 of the SABS to advise whether it has determined that the impairment is catastrophic or not catastrophic.
Who completes the medical portion of an OCF-19?
The CAT assessment is generally conducted by a physician. Where the impairment is a traumatic brain impairment only, a neuropsychologist may conduct the assessment instead.
Do attendant care benefits automatically increase when an OCF-19 is filed?
Not in every case.
Under the current SABS, if the OCF-19 is submitted no more than 260 weeks after the accident and the person was already receiving attendant care benefits immediately before the application, the insurer must continue attendant care payments during the determination period on the assumption that the impairment is catastrophic.
What happens if the insurer rejects the OCF-19?
If the insurer determines that the impairment is not catastrophic, it must provide medical and other reasons for its decision. The determination may be challenged, and unresolved accident benefit disputes can ultimately proceed before the Licence Appeal Tribunal.
