The claims process after an accident

It is a good idea to read 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.

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 insurance company not honouring your claim.

• 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

Once your claim is filed, a claims adjuster will contact you. 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.

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 they can apply 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.

As a driver you can be found anywhere from zero to 100 percent at fault. If you are found at fault, this will be recorded on your insurance record. If you are found to be 50 percent or more at fault, there is a good chance your premium will go up the next time you renew your policy.

If you lend your vehicle to someone and they are found to be 50 percent or more at fault for an accident in your vehicle, their accident will go on your record.

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.

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 does not necessarily mean you will be found not at fault. Fault will be determined through the Fault Determination Rules.

The amount you receive in compensation will depend on the extent to which the insurance company found you to be at fault, and the type of insurance coverage you purchased. Ask your claims adjuster for full details.

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

If you were found 50 percent or more at-fault for your accident, your company will pay 50 percent of any loss, less the deductible.

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 to qualify.

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

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.

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.

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)

Read the Ontario Automobile Policy for a full description of all the benefits you may qualify for.

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.

If you do not 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.

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:

Claims Adjudication and Settlement Unit
Motor Vehicle Accident Claims Fund
Ministry of Government and Consumer Services
222 Jarvis Street, 7th Floor
Toronto, Ontario M7A 0B6
Tel: 416-250-1422
Toll-free: 1-800-268-7188
Fax: 416-590-7076
E-mail: [email protected]

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.