Toronto Injury Lawyer Blog
The most important form to get treatment (physio, chrio, massage, occupational therapy, counselling, speech language etc.) after a car accident in Ontario is called the OCF-18 Treatment Plan.
This is a magical form. If the OCF-18 Treatment Plan is completed properly; then your treatment will be approved and paid for by the car insurance company.
If the OCF-18 Treatment Plan isn’t completed properly, then your treatment will be denied and you may have to pay for treatment out of your own pocket. Having Treatment Plans denied can be incredibly frustrating on your road to recovery following a serious car accident.
What’s incredible and rather perplexing for the lawyers at our office is given the importance of the OCF-18, how many times this form is updated, revised or changed. There are so many different versions of the OCF-18 it’s getting hard to keep up. Just 27 days ago (October 1, 2016), the OCF-18 Treatment Plan form was revised and changed yet again! Keep in mind that the OCF-18 is just one of the many OCF forms required in an accident benefit claim. There are over 18 other forms you may need to use during the course of your accident benefit claim.
If you visit the Financial Services Commission of Ontario website (FSCO, which is the home of the OCF forms for car accidents), you will see that there are different versions of the OCF-18 Treatment Plan, along with a wide other variety of OCF Claim Forms. For Example:
There is a Revised OCF-18 Effective October 1, 2016
There is an OCF-18 Effective June 1, 2016
There is an OCF-18 Effective November 1, 2014
There is an OCF-18 Effective February 1, 2014
The intention of car insurance and accident benefits is consumer protection legislation. It’s supposed to be easy for you, as the consumer of car insurance, to access and use that insurance to help you get better following a car accident. So why are these forms forms, which are designed to get you treatment; constantly changing. By changing these forms, isn’t it now more difficult and more confusing to get the benefits you need? That’s a very good question.
The most basic answer, using the OCF-18 Treatment Plan as our example; is that changes to the forms are necessary to keep up with the constant changes to car accident and accident benefit legislation in Ontario. The reason why car accident legislation and accident benefits are constantly changing is another story.
The newly revised OCF-18 Treatment Plan is now 9 pages. Back in 2014, the same OCF-18 Treatment plan was just 5 pages!!!! Read that again and think! So what happened from 2014-2016 such that the OCF-18 Treatment Plan has now more than doubled in size?!?!
Let’s compare the disclaimers in the 2014 OCF-18 vs. the October 1, 2016 Revised OCF-18
2014 OCF-18 Signature of Applicant
I have reviewed and agree with this Treatment and Assessment Plan. I understand that payment for this Treatment and Assessment Plan is subject to the approval of the insurer. In the event that my insurer does not agree to pay for all the goods and services contemplated in this Treatment and Assessment Plan, I understand that an examination may be required to determine my eligibility to the goods and services outlined or this Treatment and Assessment Plan. In the event that an examination is requested, I authorize my insurer and my health care providers to give the person identified by the insurer to review this application only such information relating to my health condition, treatment and rehabilitation received as a result of the accident, as is reasonably required for the purposes of determining my eligibility to benefits. As required by law, a copy of the examination report as well as the insurance company’s determination will be sent to me. Subject to the Statutory Accident Benefits Schedule, in those circumstances where prior approval is required, I understand that if I undertake any of the proposed services prior to approval by the insurer, I may be responsible for payment to my provider for any of the services rendered on my behalf. I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. I UNDERSTAND THAT IT IS AN OFFENCE UNDER THE INSURANCE ACT to knowingly make a false or misleading statement or representation to an insurer under a contract of insurance. I FURTHER UNDERSTAND THAT IT IS AN OFFENCE UNDER THE FEDERAL CRIMINAL CODE for anyone by deceit, falsehood, or other dishonest act, to defraud or attempt to defraud an insurance company
That part took up about one fifth of the page on the old OCF-18 Form. Pretty standard stuff. Not too daunting to read either. Now, let’s take a look at the wording in the updated OCF-18, which takes up and entire page in VERY fine print. Let’s just say the wording on this OCF-18 is more scary, more onerous on the accident victim, and requires a lawyer to interpret. Keep in mind, this is all just so that an injured accident victim can get a darn massage…
October 1, 2016 OCF-18 Signature of Applicant
TO THE INSURER TO WHOM THIS APPLICATION IS BEING SUBMITTED: I UNDERSTAND that you, and persons acting for you, will collect personal information and personal health information about me that is related to my claims for accident benefits arising out of the accident referenced in this Treatment and Assessment Plan, and that all such information will be collected directly from me or from any other person with my consent. I ALSO UNDERSTAND that you and persons acting for you will collect information about this Treatment and Assessment Plan prepared by my health care provider(s). I ALSO UNDERSTAND that if I am the holder of an automobile insurance policy, you, and persons acting for you, will collect the information related to this claim that is provided by me on this or any other auto insurance claim form. I ALSO UNDERSTAND that the information described above will be collected and used only as reasonably necessary for the purposes of: • Investigating my claims and processing my claims as required by law, including the Ontario Automobile Policy; • Obtaining or verifying information relating to my claims in order to determine entitlement and the proper amount of payment; • Recovering payment from insurers and others liable in law for amounts that you pay in connection with my claims; • Identifying and analyzing the nature and costs of goods and services that are provided to automobile accident victims by health care providers; • Preventing, detecting and suppressing fraud; • Compiling anonymized statistics for government agencies; and • Assessing underwriting risks and claims experience. I ALSO UNDERSTAND that you, and persons acting for you, may disclose this information to the following persons or organizations, who may collect and use this information only as reasonably necessary to enable you or them to carry out the purposes described above: Insurers; insurance adjusters, agents and brokers; employers; health care providers; hospitals; accountants; financial advisors; solicitors; organizations that consolidate claims and underwriting information for the insurance industry; fraud prevention organizations; other insurance companies; the police; databases or registers used by the insurance industry to analyze and check information provided against existing information; and my agents or representatives as designated by me from time to time. I ALSO UNDERSTAND that you, and persons acting for you, may pool this information with information from other sources and may analyze this information for the limited purpose of preventing, detecting or suppressing fraud. I CONSENT to you collecting, using and disclosing information related to this Treatment and Assessment Plan in the manner described above, but no more of such information than is reasonably necessary to meet the legitimate purpose of such collection, use or disclosure. I UNDERSTAND that if I have any questions about this consent I am free to consult with my insurance company representative or legal advisor before signing this document. I AM ALSO AWARE that you, and persons acting for you, may be required or permitted by law to disclose this information to others without my knowledge or consent. I have reviewed and agree with this Treatment and Assessment Plan. I understand that payment for this Treatment and Assessment Plan is subject to the approval of the insurer. In the event that my insurer does not agree to pay for all the goods and services contemplated in this Treatment and Assessment Plan, I understand that an examination may be required to determine my eligibility to the goods and services outlined in this Treatment and Assessment Plan. In the event that an examination is requested, I authorize my insurer and my health care providers to give the person identified by the insurer to review this application only such information relating to my health condition, treatment and rehabilitation received as a result of the accident, as is reasonably required for the purposes of determining my eligibility to benefits. As required by law, a copy of the examination report as well as the insurance company’s determination will be sent to me. Subject to the Statutory Accident Benefits Schedule, in those circumstances where prior approval is required, I understand that if I undertake any of the proposed services prior to approval by the insurer, I may be responsible for payment to my provider for any of the services rendered on my behalf. I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. I UNDERSTAND THAT IT IS AN OFFENCE UNDER THE INSURANCE ACT to knowingly make a false or misleading statement or representation to an insurer under a contract of insurance. I FURTHER UNDERSTAND THAT IT IS AN OFFENCE UNDER THE FEDERAL CRIMINAL CODE for anyone, by deceit, falsehood, or other dishonest act, to defraud or attempt to defraud an insurance company. This information will be used for processing payments of claims; identifying and analysing the nature, effects and costs of goods and services that are provided to automobile accident victims, by health care providers; and PREVENTING, DETECTING AND SUPPRESSING FRAUD. To obtain further information about how your consent relates to pooling and data analytics to prevent and detect fraud please visit http://www.ibc.ca/en/privacy-terminology.asp To obtain further information about privacy related issues please contact the Privacy Officer at the insurance company listed in Part 2
Legal analysis aside: 279 words in 2014 vs. 852 words in 2016. Simple? Consumer protection? Easy to get treatment? Easy to understand? You be the Judge.
