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Published January 13, 2021

The risk of motor vehicle accidents increases during Canadian wintertime. Given the speeds and icy conditions involved, resulting catastrophic impairment isn’t uncommon. According to the Allstate Canada 2017 Safe Driving Study, the three months with the highest number of car accidents were December, January and February.

So what if you or a loved one is the unfortunate victim of a catastrophic motor vehicle accident this season? What then? Chances are it won’t be your immediate focus given your grief and anguish. However, submitting the Application for Determination of Catastrophic Impairment to your auto insurance company, otherwise known as the OCF-19 form, is something requiring your urgent attention.

After all, this is how individuals determined to have a catastrophic impairment are entitled to request extended medical, rehabilitation, and attendant care benefits and other expenses. This is through the Statutory Accident Benefits Schedule (“SABS”) with higher amounts (up to $1 million) for catastrophic impairment victims. Ultimately, submitting this application and getting it approved means your insurer can designate you as catastrophically impaired.

Given the importance of this particular application form, this MG Law blog outlines four top tips to keep in mind when approaching catastrophic impairment determination.

1. First of all, realize what injuries automatically qualify as catastrophic

Firstly, you should know that catastrophic impairment determination is a complex and complicated task. Therefore, it’s only worth your effort should you truly believe your auto insurance company will accept your application. This is made easy however. Why? Because a particular set of injuries are automatically considered catastrophic when auto insurance companies receive form OCF-19.

In the legal sense in Ontario, these injuries are:

  • Paralysis – Either paraplegia or quadriplegia that leaves a person unable to use some or all limbs or torso which could result from a catastrophic spinal cord injury
  • Amputation – The amputation must result in complete loss of function of an arm or leg
  • Total loss of vision in both eyes
  • Severe brain impairment – Must result in 55% impairment of a person which would be a catastrophic brain injury
  • Mental or behavioural disability – Must result in 55% of a person becoming impaired in three or more functional areas

2. Make sure you’re completing the correct OCF-19 form

Importantly, the injuries outlined above are bound by specific criteria that are detailed in Appendix 1 of the newer OCF-19 for accidents that occur on or after June 1, 2016. Bear in mind that an older OCF-19 exists for accidents between November 1, 1996 and May 31, 2006 although no catastrophic criteria is detailed in this previous version. It’s absolutely vital that you print off and complete the correct version of the form. If you don’t, auto insurance companies won’t hesitate to reject your application. Ensuring your application is right the first time will save you money, time and confusion.

While you can read the newer OCF-19 criteria at your leisure, the language is highly technical and ultimately, everyday individuals won’t 100% know whether their injuries will qualify.

What individuals should know is that after form OCF-19 is submitted, auto insurance companies will either accept an application and consider an accident victim catastrophically impaired. Alternatively, they will reject the application and request that accident victims perform a series of medical examinations, also referred to as “section 44 assessments” with the aim of them meeting all qualifying criteria.

3. Recruit the right personnel in order to complete the form

Which personnel should be involved in completing form OCF-19? That’s an important question and one you should consider very carefully. Ultimately, there isn’t a one-size-fits all approach for this application and an experienced catastrophic impairment determination lawyer is best suited to guide you on this.

Firstly, a physician is required to complete Part 2 onwards within the application. Therefore, many recruit their trusted family doctor to submit these details. However, you should always assess whether they are inherently familiar with accident benefits. Ultimately, you want your auto insurance company to approve your application so oftentimes, personnel like neuropsychologists may be better suited to completing these details but this varies depending on the intricacies of your application. Remember, you’ll need to hire a specialist to deliver a medical-legal report too.

4. Consult a lawyer experienced in handling accident benefits

Determining if your injury is catastrophic, proving your innocence and navigating the legal process is highly complex. Additionally, these cases can prove time-consuming. With large sums of money on the line, we understand the stakes are high.

That’s why consulting with a catastrophic injury lawyer experienced in handling accident benefits is so important. MG Law won’t simply guide you through completing the Application for Determination of Catastrophic Impairment (OCF-19) but we’ll increase your chances of winning or reaching a successful settlement.

Remember, insurers will always be reluctant to approve your catastrophic impairment. Therefore, you need a catastrophic injury lawyer in your corner to help spare you costly medical examinations and wasted time. We have the experience and knowledge to help get you the compensation you deserve. We also communicate in English, French, Arabic, Russian and Mandarin for your total comfort and convenience.

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