Application for Accident Benefits (OCF-1) – SABS

The Application for Accident Benefits (OCF-1) is an essential form used to apply for benefits if you have been injured in an automobile accident in Ontario. This comprehensive package must be completed accurately to ensure timely processing and to determine eligibility for various benefits.

This form is crucial for initiating the process of obtaining accident benefits following an automobile accident. Ensure all sections are completed accurately to avoid delays in processing your application.

Filling out OCF-1 form accurately is crucial for ensuring that your claim is processed without delay. Here’s a step-by-step guide to help you complete each section of the form:

Part 1: Applicant Information

• Last Name, First Name, and Initial: Enter your full name as it appears on official documents.
• Gender: Check the appropriate box for male or female.
• Marital Status: Check the box that describes your current marital status.
• Driver’s Licence Number: Enter your driver’s licence number.
• Birth Date: Fill in your birth date in the format YYYY/MM/DD.
• Address: Provide your current home address, including city, province, and postal code.
• Dependents: Indicate if anyone depends on you for financial support or care and specify the number of dependents.
• Contact Information: Provide your home and work telephone numbers, fax number (if applicable), and email address.
• Best Time to Reach You: Specify the best days and times to contact you, and your preferred language.

Part 2: Applicant’s Representative (if applicable)

• Representative Details: Fill this section only if the applicant is deceased, a minor, unable to complete the form, or has retained a representative.
• Representative’s Information: Enter the representative’s last name, first name, relationship to the applicant, address, work telephone, fax number, and email address.

Part 3: Accident Details and Health Information

• Date and Time of Accident: Provide the exact date and time of the accident.
• Your Role: Indicate if you were a driver, pedestrian, passenger, or in another role during the accident.
• Accident Location: Enter the highway or street name, city, and province where the accident occurred.
• Work-Related Accident: Indicate if the accident occurred while at work and if a claim was filed with the Workplace Safety and Insurance Board.
• Police Report: State if the accident was reported to the police, and provide the officer’s name, badge number, date of report, and police department.
• Charges: Indicate if you were charged as a result of the accident and provide details.
• Accident Description: Briefly describe the accident and any injuries sustained.
• Post-Accident Activities: Indicate if you were able to return to normal activities and if you visited a hospital or health professional. Provide details of the visits and treatments received.

Part 4: Details of Automobile Insurance

• Insurance Coverage: Answer the questions to determine if you are covered under your own, a spouse’s, or another person’s policy.
• Policy Details: Provide details of the insurance policy, including the policyholder’s name, insurance company, policy number, and the vehicle’s make, model, year, and license plate number.
• Occupant Information: Indicate if you were an occupant of the vehicle at the time of the accident.

Part 5: Applicant Status

• Employment Status: Select your employment status at the time of the accident and provide details if you were employed, self-employed, a student, retired, or a caregiver.

Part 6: Student Attending School

• School Information: If you were a full-time student or recently graduated, provide the name of the school, date last attended, address, program and level, projected completion date, and current attendance status.
• Return to School: Indicate if you were able to return to school after the accident and provide the date.

Part 7: Caregiver

• Caregiver Status: If you were the main caregiver at the time of the accident, provide details of the people you were caring for, their date of birth, and whether they are disabled.
• Impact on Caregiving: Indicate if your injuries prevented you from performing caregiving activities and if you were able to return to caregiving after the accident.

Part 8: Income Replacement Determination

• Employment Details: Provide details of your employment for the past 52 weeks, including employer name and address, position, essential tasks, number of hours per week, and gross income for each period.
• Work Impact: Indicate if your injuries prevented you from working and the date you stopped working.
• Return to Work: State if you were able to return to work after the accident and provide the date.
• Income Period: Select the period during which you had the highest average weekly income.

Part 9: Other Insurance or Collateral Payments

• Other Coverage: Provide details of any other benefit plans that cover you, such as group, private, union, disability, medical, or dental plans.
• Disability Income: Indicate if you received any income from a disability plan in the past 52 weeks and provide the amount received.
• Employment Insurance: State if you are receiving Employment Insurance benefits and provide the dates and amount received.
• Social Assistance: Indicate if you are receiving Social Assistance Benefits (welfare).

Part 10: Motor Vehicle Accident Claims Fund

• MVACF Application: Complete this section only if no other insurance coverage is applicable and you are applying to the Motor Vehicle Accident Claims Fund.
• Required Forms: Ensure that the application includes a completed Notice of Collection of Personal Information Form, Form 3 – Section 6 MVACF Application for Statutory Accident Benefits, and the Motor Vehicle Accident (Police) Report.

Part 11: Direct Payment Assignment by Applicant

• Payment Direction: Indicate if you direct the insurer to pay the licensed service provider directly for approved goods and services.

Part 12: Signature

• Consent and Declaration: Read the consent and declaration carefully.
• Signature: Sign and date the form, certifying that the information provided is true and correct.

Important Tips

• Print Clearly: Ensure all information is legible.
• Complete All Sections: Incomplete information may result in delays or denial of benefits.
• Keep a Copy: Make a copy of the completed form for your records before submitting it.
• Submit on Time: Return the form to the insurance company within 30 days after receiving the package. If you are unable to do so, submit it as soon as possible with an explanation for the delay.

By following this guide, you can ensure that your Application for Accident Benefits (OCF-1) is completed accurately and submitted correctly, helping to expedite the processing of your claim.