Ontario accident benefits
ONE FORM.
MANY
QUESTIONS.
A regulated health practitioner uses the Treatment and Assessment Plan to explain what accident-related care is proposed, why it is reasonable and necessary, how long it may take, and what it will cost.
The completed plan is submitted for the automobile insurer’s review. The insurer then communicates which proposed goods and services it agrees to fund and which it refuses, with reasons for any refusal.
01 / First distinction
What the form is—
and what it is not.
Confusion often begins when the OCF-18 is treated as several documents at once. Its role is specific.
A treatment and assessment proposal
It links accident-related impairments and functional problems with proposed goals, services, duration, and costs.
An invoice
Approved and delivered services are billed separately using the applicable automobile insurance invoicing process.
A guarantee
A provider’s recommendation and client signature do not determine whether the insurer will approve payment.
A complete clinical record
The form summarizes information needed for the claim process. Clinical records contain different and often more detailed information.
From concern
to insurer response.
Clinical review
The provider assesses the concern or reviews enough information to justify a proposed assessment or treatment plan.
Plan prepared
Accident-related problems, goals, barriers, services, duration, providers, and estimated costs are documented.
Client reviews
You review the plan, ask questions, correct errors, understand the consent language, and complete required client sections.
HCAI submission
The health-care facility transmits the plan through Ontario’s Health Claims for Auto Insurance system.
Insurer decision
The insurer identifies what it agrees or refuses to pay for and gives reasons for refused items.
Under section 38 of the Statutory Accident Benefits Schedule, the insurer generally must provide notice within 10 business days after receiving the plan. Claim-specific rules and exceptions may affect what follows.
03 / What the plan explains
The clinical logic
must be visible.
A strong plan makes the connection between the collision, the psychological impairment, the effect on daily function, and the requested service understandable.
Accident-related problemsPsychological diagnoses or clinically supported problems linked to the collision, with relevant pre-existing conditions identified separately.
Activity limitationsEffects on driving, work, sleep, self-care, relationships, concentration, community access, rehabilitation, or other daily tasks.
Recovery barriersPain, fear, avoidance, poor sleep, cognitive difficulty, medication effects, multiple injuries, social stress, or interrupted care.
Measurable goalsTargeted changes in symptoms and function, such as safer driving, better sleep, improved mood, or increased work tolerance.
Proposed servicesType of assessment or treatment, provider, number and length of sessions, frequency, delivery format, and related goods or services.
Estimated costsProfessional services, form-related fees where applicable, and other proposed expenses displayed for insurer review.
What may be
proposed?
Interview, record review, standardized measures, diagnostic and functional analysis, report preparation, and feedback when clinically appropriate.
Structured care for trauma symptoms, driving anxiety, depression, adjustment, pain-related distress, sleep, anger, or functional recovery.
Review of symptom and functional change, response to treatment, remaining barriers, prognosis, and updated recommendations.
Clinically necessary communication with authorized medical, rehabilitation, claim, legal, or workplace participants.
Graded driving exposure, return-to-work preparation, activity restoration, coping practice, or other goal-directed intervention.
Where justified and agreed, services may occur in a relevant community, home, work, or driving context rather than only in an office.
Three roles.
Different decisions.
Provides accurate information, reviews the proposed plan, asks questions, completes required client statements, and understands potential financial responsibility.
Assess clinical need, certify the plan within professional scope, specify services and costs, obtain required consent, and submit through HCAI.
Reviews the submission under the policy and applicable rules, then communicates agreement or refusal and the reasons for refused goods or services.
06 / Before you sign
Read the plan
as a participant.
Your signature should follow an opportunity to understand the proposal and correct important errors. Ask for an explanation in plain language.
Your identifiersName, date of birth, accident date, insurer, claim number, and contact information are accurate.
The accident connectionThe described psychological problems and functional changes accurately reflect your experience.
Goals and servicesYou understand what is proposed, who will provide it, how often, for how long, and whether care is virtual or in person.
Costs and paymentYou know what is being requested, whether direct billing is planned, and who may owe fees if the insurer does not pay.
Information sharingYou understand what information is authorized for collection, use, or disclosure and how it relates to the claim.
A copy and next stepsAsk how to obtain a copy, how the insurer’s response will reach you, and whether treatment will wait for approval.
Approved, partly approved,
or refused.
The insurer agrees to pay for identified goods and services. Confirm any limits, conditions, approved amount, and treatment period before care proceeds.
Some items, costs, sessions, or services are accepted while others are refused. Compare the response line by line with the submitted plan.
The insurer refuses some or all proposed services and should explain the medical and other reasons relied upon. The next step depends on those reasons and the claim context.
A denial is a funding decision.
Read the reasons.
- Obtain the written response. Identify exactly which goods or services were refused and why.
- Check for correctable issues. Missing information, inaccurate coding, unclear goals, or absent supporting records may require clinical review.
- Discuss the treatment impact. Ask the provider whether the plan should be clarified, changed, or supported by further information.
- Consider other payment routes. Extended health benefits, private payment, another program, or adjusted services may be possible.
- Get legal advice when needed. A psychologist can explain clinical recommendations but cannot advise you on disputing an insurer’s decision.
Before submission.
What is an OCF-18?+
It is Ontario’s Treatment and Assessment Plan. A regulated health practitioner uses it to propose accident-related assessments, treatment, rehabilitation goods, or services for an automobile insurer’s review.
Does signing guarantee approval?+
No. Your signature confirms the required client statements and consent or authorization described on the form. The insurer still reviews the plan under the policy and applicable rules.
How long does the insurer have to respond?+
Under section 38 of the Statutory Accident Benefits Schedule, the insurer generally must give notice within 10 business days of receiving the plan. Exceptions and claim-specific issues may affect the process.
Can treatment start before approval?+
Starting before approval can create financial risk because payment may be refused. Some services or circumstances follow different rules. Confirm authorization and responsibility for fees before beginning.
What if the plan is denied?+
Review the written reasons, discuss possible clarification or additional clinical information with the clinic, and ask about other funding. Seek qualified legal advice for rights, deadlines, or disputes.
The form should
make sense to you.
Our clinic can explain the clinical service being proposed, the goals, the estimated course of care, and the information required for submission.