Helping Families of Injured Ontario Motorists
Since 1936, Thomson Rogers has been helping seriously injured motorists get the treatment and care they need to recover from their injuries and to receive compensation for their losses. We understand that it is not only the injured party that may require assistance, as often it is loved ones that face significant challenges in helping the accident victim.
As a family member of the accident victim, you may qualify for benefits without tapping into the injured person’s benefits. Family members, even though they were not injured or even in the accident, can and should open up their own accident benefits claims to have an insurance company fund the assistance they require.
In Ontario, no-fault accident benefits are available from an insurance company to anyone injured in a motor vehicle accident whether they were driving, a passenger, a motorcyclist, a pedestrian, a bicyclist hit by a car, etc.
Who can open up an accident benefits claim?
Anyone impacted by an injury to somebody they care about can start their own accident benefits claim. Most commonly it is the children or spouse of the injured party but it could include any friend, relative, girlfriend/boyfriend, etc.
To initiate a claim, you must submit the following two documents to the appropriate insurance company:
If your psychological or emotional state impacts your ability to work then you may qualify for an income replacement benefit. In this case, you will also need to submit an Employer’s Confirmation Form OCF-2.
Completing the Application for Accident benefits
The Application for Accident Benefits (OCF-1) is meant to help the insurer gather basic information about your identity and your circumstances including your employment.
The application requires a description of the accident. As the individual applying was not in the accident or injured in the accident, they should clearly state so in this section. A simple example of what to write would be, “My husband suffered a significant brain injury in a motor vehicle accident on January 15, 2019, and his injuries have had a profound psychological impact on me even though I myself was not in the accident.”
On the forms, you will have to disclose any group health plans that may be available to you as the Ontario no-fault insurance system requires you to first try to access any group health insurance before asking the no-fault insurer to pay any benefits.
The Importance of a Properly Completed Disability Certificate
To successfully start your own accident benefits claim you will need a treatment provider (ideally your family physician) to diagnose your need for assistance and to complete a Disability Certificate OCF-3.
The most common diagnosis that family members suffer from is an “Adjustment Disorder”. An Adjustment Disorder is defined as “a group of symptoms, such as stress, feeling sad or hopeless, and physical symptoms that can occur after you go through a stressful life event”.
There are other psychological conditions that may be considered such as Depression or Post-Traumatic Stress Disorder. However, an Adjustment Disorder is often the diagnosis most appropriate as it expressly highlights the ‘adjustment’ you are dealing with caused by the injuries to your loved one.
If your condition impacts your ability to work, your physician must answer the questions on the Disability Certificate about your inability to work in order to potentially qualify you for income replacement benefits.
Within the Disability Certificate, there will be a question about whether you have suffered a “complete inability to carry on a normal life”. If your condition is debilitating, then the physician should answer ‘yes’ so that you may qualify for a non-earner benefit (if you are not employed).
If your doctor confirms that your condition impacts your ability to work, then you must also submit an Employer’s Confirmation Form OCF-2.
If your condition impacts your ability to work then you should have your employer complete an OCF-2 stating your employment status and income.
Which insurer do I advance my accident benefits claim to?
If you have car insurance then you should advance your accident benefits claim to your own car insurer.
Unlike the injured person’s claim, your accident benefits claim cannot be advanced to the insurer of any other vehicles involved in the accident (unless you are also in the accident). If you do not have car insurance, then these claims are advanced to the Motor Vehicle Accident Claims Fund. In some circumstances, access to this Fund may not be available such as for foreigners.
What happens when I start my own Accident Benefits claim?
If the OCF-3 Disability Certificate confirms a psychological injury then you should be eligible for non-catastrophic accident benefits.
More specifically, you should be eligible for up to $65,000 in medical and rehabilitation benefits and/or attendant care benefits.
If your condition impacts your ability to return to work, you will be eligible for income replacement benefits of up to 70% of your gross income from before the accident (to a maximum of $400 per week).
These benefit amounts may be greater if you purchased optional benefits from your car insurer.
How will my insurer respond to my claim?
Most insurers understand that the entire family unit is affected when a loved one is involved in a serious accident. Accordingly, insurers are often sympathetic in their approach to claims by family members and agree to fund the treatment required.
What happens when my accident benefits claim is opened?
Once your accident benefits claim is opened, you will be able to ask treatment providers, like psychologists or social workers, to submit treatment and assessment plans to the insurer for approval to provide treatment to you at the insurer’s expense.
You may also be able to access physical treatment services such as massage therapy, chiropractic treatment, physiotherapy, etc., if your condition is causing physical issues.
No, in fact, your own accident benefits claim may help support your loved one’s claim as:
- Your loved one may be distraught over the impact the accident is having on you. Seeing you have your own accident benefits claim and being able to access your own treatment at the insurer’s expense may prove to be a source of relief for them.
- In the lawsuit advanced against at-fault motorists, the Defendants will better understand the ramifications of the accident by appreciating that the family members have started their own accident benefits claim to access needed treatment.
It should be noted that family members can participate as claimants in lawsuits against at-fault drivers in serious cases.
What can the insurance company do to challenge my claim?
The insurer can try to elicit more information to better understand your claim. They can do so in a number of ways such as requesting an Examination Under Oath; a Statutory Declaration; or request a host of medical documents to understand your situation.
You will have an obligation to cooperate with the insurer but you may wish to speak with a qualified personal injury lawyer about the scope of their requests in order to make sure that they are being reasonable.
How can Thomson Rogers help you?
It is important to understand that starting your own accident benefits claim means that you may be able to access your own treatment without encroaching on your loved one’s benefits.
With over 80 years of experience helping victims of accidents, Thomson Rogers has the advocacy skills to help you and your loved ones receive the benefits you deserve.
If you have more questions about this information kit, please contact the personal injury lawyers at Thomson Rogers at 416-868-3100, Toll-free at 1-888-223-0448 or by e-mail at firstname.lastname@example.org.