MVA Forms
What is an OCF-1 form? Why is it important?
The OCF-1 is the Application for Benefits. This is a mandatory form that all MVA patients must complete, to apply to their auto insurance company for coverage for treatment related to the accident. The form asks clients about their car insurance and policy information, employment/caregiving/student status at the time of the accident, and whether they have EHB's ect.
The patient is responsible for completing this form and submitting it to their adjuster. Failure to do so means that the clinic will not get paid for treatment rendered, that is otherwise approved under an OCF-18/23.
A copy must be faxed to the adjuster and scanned to the patient's file in Jane.
We did the intake - Can we book in right away, or do we talk with adjustor first?
We can book all MVA claims an assessment unless: the accident date is more than 1 year ago, RMT only is requested, or a lawyers office calling us to accept a referral we can book an appointment. Any of these situations require us to get in touch with adjuster to request further details prior to taking on the case.
A patient drops in to book an appointment for Physio after getting into a car accident last week. During your discussion, you ask if they’ve reported the accident to their insurance company yet, and if they also have an Adjuster for the claim. The patient is confused and says they don’t know what an adjuster is. Please describe who an Adjuster is for them, and what they do?
An adjuster is an insurance professional employed by an insurance company to investigate, manage, and settle claims arising from car accidents. They act as the primary contact for policyholders, determining the validity of a claim, assessing damages to vehicles, and handling medical injury.
What do we need to take a copy of and/or put on file, for a new MVA client after their initial assessment is complete?
Valid government ID & credit card
Patients are taken out of the MIG if....
- They have a concussion diagnosis
- Are in need of supplementary care
- have fractures or require surgery as a result of the accident
A therapist dropped off an OCF-24 form in the white tray at the Big Desk. What is it? What do we do with it?
OCF-24 is the discharge report that must be filled out once a patient has completed an OCF-23 (MIG). A signed copy must be scanned into the patient's file and then faxed to the Adjuster, and updated in the slack channel when received.
What can we share vs not share when an adjuster or lawyer calls asking about claims?
We can provide the last attended treatment date. All other inquires can get tricky. It is best to take a name and number, so we can follow-up at a later time.
A patient under an OCF-23 needs to book some massage appointments with Sang. They have Sun Life EHBs that we can direct bill. What type of appointment do you book in Sang’s schedule? When submitting to Sun Life, what information do you enter for the length of the appointment and its cost?
In Jane, we will book a 45-minute massage and direct-bill to Sun Life at full cost.
Name all the OCF forms that need to be faxed to the adjuster.
OCF-1: Application for Benefits
OCF-3: Disability Certificate
OCF-5: Permission to Disclose Health Information
OCF-24; Discharge Report
Which RMT's on staff do MVA massage?
Currently all of our RMT do MVA massage.
This is known as the Minor Injury Guideline (MIG) Assessment & Treatment Form
OCF-23
What is a settlement account?
When clients have exhausted their Accident Benefits claim and/or care is denied by adjusters despite IMEs— they still need ongoing treatment but have no available payor. They retain a lawyer to pursue an auto lawsuit, and if successful, the clinic is paid for the care provided.
A lawyer calls into the clinic and wants to refer a client of theirs who had an accident in March 2022. What would you say to them?
Due to the date of injury being over a year, we will take down your name, number and email as our MVA coordinator will have to follow up to gather further details about the client/claim.
Helpful tools in the google drive that admin can utilize for tracking patient's treatment plans and visits.
MVA tracker/google sheets
Disclaimer: Look in Jane for the last appointment vs the sheet for accuracy as the tracker is not updated daily.
Health Claims for Auto Insurance is also known as......
HCAI
Candice drops off an OCF-3 in the white tray at the big desk. What is it? What do you do with it?
OCF-3: Disability Certificate - This is a two-part form completed by the patient and therapist, used to apply for short-term disability benefits and to recoup funds lost as a result of being off work because of the accident.
A completed and signed copy must be scanned into the patient file. When a copy is received, please post this update in the MVA Slack channel, and fax off to the adjuster.
Do we always receive referral paperwork?
No - Although it would be helpful, referral's are not required from lawyers, auto insurance companies or hospitals.
An adjuster calls into the clinic about one of our mutual MVA cases, and has questions about the invoice we billed in HCAI. How do you tackle this?
Take down their name, number and/or email and let them know Virginia will follow up at her earliest convenience.
What information does the Admin team need from new patients who will be coming in for treatment because of a car accident?
First and Last Name, DOB, DOL, Injuries/Description of accident, Adjuster Information, Automotive Information, EHBs(?)
How many weeks of treatment are available in an OCF-23?
An OCF-23 (Treatment Confirmation Form) for the Minor Injury Guideline (MIG) in Ontario typically covers 12 weeks of care.
This treatment form is used in two circumstances 1) after a patient has completed a MIG and more treatment is necessary OR 2) when the injuries sustained by the patient are not considered within the MIG.
OCF-18: Assessment & Treatment Form
Do we always require the signed OCF-1 on file?
Yes, without it, technically no active claim exists for the patient with the auto insurance company - and the clinic will not get paid for the care provided.
A parent of a potential new patient calls in. The parent is worried that their 4 yo son may have a concussion due to a car accident they had last week. We have resumed taking MVA cases again. Who could you book the patient in with?
Rachel, Candice or Troy.
Paul COULD take on the case... but prefers to avoid working with children this young.
We are required to keep a paper copy of this form for several years......
OCF-21: Invoice
What is CAT?
Catastrophic Impairment (CAT): the highest classification of injury under Ontario’s auto insurance laws. It dramatically increases the benefits available to an injured person — including access to long-term medical, rehabilitation, caregiver, housekeeping, and attendant care supports.