The claims process after an accident

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 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.

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.