No-fault insurance in Ontario allows motor vehicle accident victims to receive funding for treatment, lost income, and other benefits. However, in order to receive this funding, an Accident Benefits Application Package must be completed. This package includes an Application for Accident Benefits (OCF-1) form, as well as a Disability Certificate (OCF-3) form.
The Disability Certificate asks questions relating to your employment status, caregiver status, and student status at the time of the accident. Depending on your answers, you can elect to receive Income Replacement Benefits (IRBs) through the Disability Certificate.
Your no-fault insurer is obligated to pay IRBs if you were employed at the time of the accident, were receiving EI benefits, or were employed for at least 26 weeks in the year before the accident and, as a result of and within the first two years after the accident, suffer a substantial inability to perform the essential tasks of that employment. Depending on your pre-accident income, IRBs will provide between $185 and $400 on a weekly basis for up to the first two years after the accident while you are unable to work because of your accident-related injuries. If you suffer a complete inability to work in employment for which you have education, experience, and training, you may be entitled to received IRBs post-two years after the accident to the age of 65. After the age of 65, the IRBs are adjusted, i.e. reduced and you could received through to your lifetime until your death.
Even if you do not qualify for IRBs, you may still be eligible to receive non-earner benefits (NEBs). Non-earner benefits are available to those who do not qualify to receive IRBs and suffer a complete inability to carry on a normal life as a result of and within the first two years after accident. The threshold to qualify for NEBs is higher than that of IRBs, and the benefit will provide a maximum of $185 weekly, minus any other income replacement assistance received. You must suffer a complete inability (i.e. a substantial inability) to carry on your activities of daily living.
However, it is imperative to note that your no-fault insurer is not obligated to pay any IRBs or NEBs during any time in which your Accident Benefits Application Package is incomplete. Specifically, no-fault insurers have found success in arguing that they should not have to pay for IRBs and NEBs when an accident victim fails to submit a completed Disability Certificate.
Section 36 of the Statutory Accident Benefits Schedule sets out the process for claiming income replacement and non-earner benefits. Accident victims are only entitled to IRBs or NEBs for any eligible period after the completed OCF-3 is successfully submitted to their no-fault insurer. There are no exceptions to this rule, nor any statutory provisions to allow for reasonable explanations for late submissions. The law is clear that an insurer is not required to make any payments for IRBS or NEBs prior to the receipt of a completed OCF-3.[4]
There is, however, a split onus to prove that an OCF-3 has been submitted to the insurer. If an insured accident victim can show, for example, a fax confirmation that they submitted the OCF-3 to the no-fault insurer, then the no-fault insurer must also produce evidence to show that the fax service used was not reliable or reachable if they claim non-submission at the License Appeal Tribunal.[5]
All of this to say is that completion and submission of the Disability Certificate is an imperative step for accident victims who are eligible to receive IRBs or NEBs. As you can see, navigating accident benefits can be difficult and time-consuming, and there are many ways in which your no-fault insurer may attempt to deny you benefits. There is no replacement for having a team of legal professionals by your side through every step of the process to advocate for your interests.
If you or someone you know has gotten into a motor vehicle accident, you may be eligible for benefits and compensation. Contact our team at JEWELL RADIMISIS JORGE LL.P for a free consultation.