You’ve been in an accident and need to make a claim. The following will help you understand the process and lead you to the best possible outcome. If you need more information on your particular situation, you will need to speak to your insurance agent, broker, or company representative.
Understand your policy
It's a good idea to sit down and read over your Ontario Automobile Policy (OAP 1) to understand your coverages, rights, and responsibilities.
If you do not have a copy of the Ontario Automobile Policy (OAP 1), ask your insurance agent, broker, or claims adjuster for one, or download a copy now.
How and when to file an accident report
Following an accident, you must file a report with your broker, agent or insurance company within seven days—or as quickly as possible after that. Failing to report within a reasonable amount of time may result in your claim not being honoured.
You will need to provide the following when making your report:
- Your policy number
- Make, model, year, registration and licence plate number of the vehicle
- Accident details – driver’s name and licence number (if the driver was not the registered owner)
- Date, time and location of the accident
- Extent of any injuries
- Number of passengers involved
- Extent of damage to the vehicle
- Your description of the accident
- Names and driver’s licence numbers of all drivers involved
- Names of insurance companies, and auto insurance policies of all drivers involved
- The name and badge number of the investigating officer – if the accident was reported to police
What happens after you file a claim
Once your claim is filed, you will be contacted by a claims adjuster. They may require that you complete a Proof of Loss form. The adjuster will determine how much of your claim your insurer will cover, and guide you through the claims process.
How fault is determined
After you report an accident, your insurance company will determine fault by following the Insurance Act and Fault Determination Rules. These rules:
- Use diagrams to cover more than 40 accident situations that can be applied to almost every possible road collision scenario
- Are applied regardless of road or weather conditions, visibility, point of impact on the vehicles, or the actions of pedestrians
Note that in some cases, fault may be shared between multiple parties involved in an accident.
How fault affects you as a driver
As a driver you can be found anywhere from zero to 100 per cent at-fault following an accident. If you are found at-fault, this will be recorded on your insurance record. If you are found to be 50 per cent, or more, at-fault, there is a good chance your premium will go up the next time you renew your policy.
Note that if you lend your vehicle to someone and they are found to be 50 per cent, or more, at-fault for an accident in your vehicle, their accident will go on your record."
What to do if you disagree with your insurance company’s assessment of fault
If you believe your insurance company made an error in settling your claim, ask your claims adjuster which Fault Determination rule was applied in your case. If your insurance company refuses to revise their decision and you still disagree, contact your insurance company’s complaint officer.
Police charges, convictions and at-fault determination
If you are charged with an offence, it does not necessarily mean you will be found at-fault for insurance purposes. Similarly, if you are not charged with an offence, it doesn’t necessarily mean you will be found not at-fault. Fault will be determined through the Fault Determination Rules.
What to expect if your vehicle has been damaged
The amount you receive in compensation will depend on the extent to which you were found at-fault for the damage, and the type of insurance coverage you purchased. Ask your claims adjuster for full details.
What to expect if you file a claim with mandatory coverage only
In Ontario, your mandatory coverage includes Direct Compensation-Property Damage (DC-PD). Depending on the extent to which you were found at fault, you may be eligible to receive costs for:
- A temporary rental vehicle
- Damaged personal contents inside the vehicle
Note that if you were found 50 per cent, or more, at-fault for your accident, and therefore 50 per cent not-at-fault, your company will pay 50 per cent of any loss, less the deductible.
What to do if the other driver involved has no insurance
If any other vehicle in the accident was uninsured, you can make a claim under the mandatory Uninsured Motorist Coverage of your policy. Coverage is up to $25,000, less the first $300. You must be able to identify the owner or driver of the other vehicle in order to qualify.
What to expect if you file a claim with mandatory plus optional coverage
Specified Perils Coverage
If you purchased Specified Perils Coverage you will be covered for:
- Theft or attempted theft
- Lightning, windstorm or hail
- Rising water
- Earthquake or explosion
- Riot or civil disturbance
- Falling or forced landing of an aircraft or parts of an aircraft
- The stranding, sinking, burning, derailment, or collision of any kind of transport in, or on which, your vehicle was being carried on land or water, regardless of fault, less the deductible you chose at the time you purchased the coverage
If you purchased Comprehensive Coverage you will be covered for the repair or replacement of your vehicle due to a non-collision loss, including those perils listed under Specified Perils, falling or flying objects, missiles and vandalism, regardless of fault, less the deductible you chose at the time you purchased the coverage.
Collision or Upset Coverage:
If you purchased Collision or Upset Coverage, your insurance company will pay to fix or replace your vehicle if it is damaged in an accident, regardless of fault, less the deductible you chose at the time you purchased the coverage. This also includes cases where an uninsured driver cannot be identified, or damaged your vehicle.
All Perils Coverage
If you purchased All Perils Coverage, your insurance company will pay for all losses noted above, less the deductible you chose at the time you purchased the coverage.
How insurance companies decide whether to repair or write off your vehicle
When you make a claim, your insurance company will pay the lower of the two options:
- The cost to repair the loss or damage
- The "actual cash value" of your vehicle at the time it was damaged
- Your insurance company will not pay more to repair your vehicle than its actual cash value.
How deductibles work
When you file a claim, you may be responsible for a deductible—the amount of the claim you will have to pay. You can expect to pay your full deductible unless the accident was not your fault, or was only partially your fault.
What to expect if you’ve been injured
In Ontario, Statutory Accident Benefits Coverages are provided by law under every auto insurance policy. These benefits provide compensation, regardless of fault, if you, your passengers, or pedestrians are injured, or die as the result of your accident.
If you are injured in an auto accident, you may be entitled to the following benefits:
- Income replacement: replaces job income you cannot earn while recovering
- Caregiver: provides compensation if you are required to leave work to care for an injured member of your household
- Non-earner: provides compensation if you are completely unable to carry on a normal life, and do not qualify for an income replacement or caregiver benefit
- Medical: pays for medical expenses incurred through your injury
- Rehabilitation: pays costs incurred during rehabilitation
- Attendant Care: pays some of the costs of an aide or attendant
- Compensation for Other Expenses: may pay for the cost of family visits during treatment or recovery, some housekeeping and home maintenance, the repair or replacement of some items lost or damaged in the accident, or lost educational expenses.
What your family can expect if you die as the result of an accident
If you die as a result of the accident, members of your family may also be entitled to the following benefits:
- Death: pays money to members of your family
- Funeral: pays for some funeral expenses
In some cases, your insurance company may deny payment of Income Replacement, Non-earner and Compensation for Other Expenses. Cases include:
- Driving without valid insurance
- Driving without a valid driver's licence
- Driving while specifically excluded from driving under your insurance policy
- Driving a vehicle without the owner’s consent
- Cases of fraud
- Driving a vehicle while committing a crime (whether or not the crime is related to the operation of the vehicle)
Applying for accident benefits
When applying for accident benefits, your claims adjuster will provide you with an Accident Benefits Application Package that will include the following five forms:
- Application for Accident Benefits (OCF-1)
- Employer's Confirmation of Income (OCF-2)
- Disability Certificate (OCF-3)
- Permission to Disclose Health Information (OCF-5)
- Treatment Confirmation Form (OCF-23)
Once your Accident Benefits Application Package has been reviewed, your insurance company will let you know which benefits you qualify for.
Applying for accident benefits if you don’t own an auto insurance policy
If you don't own your own auto insurance policy, and are not listed on someone else's policy, you can still make a claim if you are injured in an accident.
This chart will help you to determine where to send your Accident Benefits Application Package.
|Your situation/circumstance||Where to send your application|
|You were driving a company vehicle||The insurance company that insures the company vehicle|
|You were a passenger in someone else's vehicle when injured||The insurance company that insures the vehicle|
|You were a passenger in an uninsured vehicle in a multi-vehicle accident||The insurance company of an insured vehicle involved in the accident|
|You were a pedestrian or cyclist||The insurance company of the vehicle that hit you|
None of the above
|The Motor Vehicle Accident Claims Fund (MVACF)|
What is the Ontario's Motor Vehicle Accident Claims Fund (MVACF)?
The MVACF is considered the "payer of last resort" for people injured in auto accidents when no auto insurance policy exists to cover the claim. To make a claim, contact the fund at:
Motor Vehicle Accident Claims Fund
Ministry of Government and Consumer Services
5160 Yonge Street
Suite 805, Box 28
Toronto, Ontario M2N 6L9
Email: [email protected]
What to do if you and your insurance company disagree about your accident benefits
If you and your insurance company can’t come to an agreement about your accident benefits, you can apply to Automobile Accident Benefits Service (AABS) to resolve your dispute.