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Ten Points you need to know about the Treatment and Assessment Plan (OCF-18)

After a Serious Car Accident, What you should know about  Ontario Claims Form 18

Following a car accident, motorcycle accident or any other type of serious accident involving a motor vehicle, it can be an emotionally challenging and sometimes confusing time. There can be unexpected expenses made more difficult by time lost at work, and depending on the extent of your injuries, you may need to see your doctor about receiving a treatment plan for your injuries.

Back injuries, neck  and head injuries, spinal cord injuries and any broken bones will take time to heal. In many cases you will need the help of a physiotherapist, massage therapist or chiropractor to help you along the way. After an accident, your insurance provider should offer you an application for accident benefits. This will help to cover the expenses related to your injuries.

How your Ontario Personal Injury Lawyer can help

To receive accident benefits you need to complete an OCF-18 or Ontario Claims Form.
This is done through the Health Claims for Auto Insurance (HCAI) system.  The following tips are 10 points from a personal injury lawyer that are important for accident victims or their families to be aware of when they begin the process of being treated for serious personal injury.

We recommend that you print a copy of this list to keep with your insurance policy. In the event of an accident, this information can be helpful not only for yourself, but also to those who may be working together on your treatment plan.

Personal Injury Treatment and Assessment Download OCF-18

Talk to an Ontario personal injury lawyer about any questions you may have about the treatment and assessment process. We can assist you in gaining compensation for personal injury from your car accident, and make sure that you receive a fair settlement for any claims.

1. Insured’s/clients are given copies of the OCF-18 from their insurers in their application for accident benefits package.

2. Insured’s/clients must then provide their family doctor with this OCF-18 as their family doctor will/may want to refer them for treatment.

3. Insured’s/client can also attend themselves to any treating facility advising that facility that they have been referral for a certain type of treatment (i.e.. massage therapy, physiotherapy, chiropractic therapy…)

4. The following health care professionals or providers can submit OCF-18s….Chiropractors, Dentist, Nurse Practitioners, Occupational Therapist, Optometrist, Physician, Physiotherapist, Psychologist or a Speech Language Pathologists.

5. The Health care provider must also make themselves aware if the insured/client falls under the “Minor Injury Guideline” and submit their OCF-18 accordingly.

6. Treatment provider and/or health care providers are obligated to submit their OCF-18 through the “Health Claims for Auto Insurance” (HCAI) system. Which is part of an ongoing effort to improve the delivery of health care benefits to Ontarians injured in automobile collisions. Building on the Auto Insurance Standard Invoice (OCF-21), HCAI seeks to automate the exchange of standardized health claim information between health care providers and insurance companies.

7. An OCF-21 (Auto Insurance Standard Invoice) form will need to be submitted with the OCF-18 also through HCAI for reimbursement of the completion of the OCF-18. A maximum amount of $200 is payable to health care providers for the completion of the OCF-18.

8. According to section 38(8) of the SABS Insurer’s have 10 business days after they receive the OCF-18 to give the insured person a notice that identifies the goods, services, assessments and examinations described in the OCF-18 that the insurer agrees to pay for, any the insurer does not agree to pay for and the medical and any other reasons why the insurer considers the goods, services, assessments and examinations, or the proposed costs of them, not to be reasonable or necessary.

9.If the insurer fails to give a notice in accordance with subsection (8) above in connection with an OCF-18, the following rule applies…the insurer shall pay for all goods, services, assessments and examinations described in the OCF-18 that relate to the period starting on the 11th business day after the day the insurer received the application and ending on the day the insurer gives a notice described in subsection (8).

10. After the treating doctor / health care providers have submitted their OCF-18 and have completed their treatment that was approved by the insurers they are encouraged to submit another OCF-18 if they feel it is necessary for additional treatment.

If you have questions about how to get help with the costs related to your accident, or whether you may be entitled to a settlement for your serious injuries, call our office at 1-800-563-6348 or email an Ontario personal injury lawyer.

This post was co-authored by Abby Laurin, Paralegal in collaboration with Ontario Injury Lawyer, Michael Laplante

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