Understanding Your Accident Benefits

Notify your own insurance company within seven days of the collision. Do it by phone and follow up in writing so there is a record.

You are reporting, not admitting anything. If you are unsure what to say, describe what happened factually and avoid guessing about fault or about how badly you are hurt.

How we help. Call us and we will explain the reporting process and the timelines that apply. People often describe themselves as fine in those first days because adrenaline masks a great deal, so we will also talk through the symptoms worth mentioning to your insurer and your doctor, including the ones patients commonly overlook. Our phone line is answered 24 hours a day.

Your insurer must send you the application package. You generally have 30 days from receiving it to complete and return the OCF-1, which opens your claim.

It asks about your work, your income, and the household tasks you can no longer manage. Answer fully. People routinely understate their difficulties out of politeness or optimism, and that early document follows the claim.

How we help. We complete this paperwork with you. Our Registered Social Workers are familiar with these forms and will make sure the sections on household tasks, work and mood are completed accurately, since those are the areas people most often leave incomplete. Where a form needs a prescriber, our nurse practitioners complete it.

Get seen even if you feel able to carry on. Adrenaline masks injury, and whiplash, concussion symptoms and soft tissue injury often declare themselves in the second week.

Describe everything, including headaches, poor sleep, irritability, difficulty concentrating and reluctance to get back in a car. This visit creates the first medical record connecting your symptoms to the collision.

How we help. We assess you ourselves, and we ask about the things people leave out of a medical appointment: sleep, nightmares, irritability, concentration, fear of driving, and how you are managing at home. That becomes the first proper record connecting your symptoms to the collision.

A provider assesses you and submits an OCF-18 treatment plan to your insurer, setting out what treatment is recommended and why.

Each discipline submits its own plan. If you need counselling and physiotherapy, those are two separate requests with separate approvals.

How we help. We prepare and submit the treatment plan. Each discipline submits its own, and where more than one is involved we coordinate them. Our assessments document impairment objectively, including FDA-cleared measurement of sleep, driving anxiety and physical function on the assessments where those apply, which is considerably harder to dispute than description alone.

Your insurer has ten business days to respond to a funding request. They may approve it, approve part of it, request an assessment of their own, or deny it.

Ten business days is two calendar weeks, which is a long time when you cannot sleep, cannot work, or are in pain. Because of that, we may begin treatment before funding is confirmed, decided case by case.

How we help. We track the ten business days and follow up so nothing sits unanswered. If a plan is denied, we prepare the response and the supporting documentation. Because we would rather not leave you waiting, on a case-by-case basis we may begin treatment before funding is confirmed.

Approved treatment is billed directly to your insurer, so it costs you nothing out of pocket. You do not pay and claim back.

Your provider reports on your progress as treatment continues, and submits a further plan if more is needed.

How we help. Treatment happens with us: counselling and trauma therapy, physiotherapy, and dietitian care. At our four clinics, in your own home, or online anywhere in Ontario. We re-measure as we go so progress is documented, we report to your insurer, and we tell you when you no longer need to come.

A framework that caps treatment funding at $3,500 for injuries classed as minor, such as sprains, strains and uncomplicated whiplash.

Many people are placed here early, sometimes before anyone has properly assessed them. A documented psychological injury is one of the recognised routes out of the guideline, which is why proper assessment early matters so much. That documentation usually comes from an assessment by a Registered Social Worker or psychotherapist, or, where a formal diagnosis is needed, from a psychologist, physician or nurse practitioner.

If you have been told you fall under it and that does not match how you are, that decision can be challenged with clinical evidence.

The category most claims fall into once they are outside the Minor Injury Guideline. The current limit is $65,000 combined for medical and rehabilitation care.

That is usually enough to fund a proper course of treatment across more than one discipline.

For the most serious injuries, raising the limit to $1,000,000 for medical, rehabilitation and attendant care combined.

Catastrophic status is determined against defined criteria and requires a multidisciplinary assessment. We coordinate and complete these, including the psychological and functional components.