Understanding and Navigating Auto Claims as a Physiotherapist: A Brief Overview 

General Definitions

Treatment Plan Pathways

Is the Injury Classified as Minor within the Statutory Accident Benefits Schedule? 

If YES, Use the MIG Pathway: 

• Submit OCF-23 of up to $2600 ($2200 for treatment, $400 for supplementary goods and services)

• Deliver care in 3 treatment blocks (Week 1–4, Week 5–8, Week 9–12) 

• Invoice using OCF-21C with flat fees per block 

• If more care is required, re-assess and submit an OCF-18 for up to $1300.00 

• Total maximum: $3,500  

If NO, use the Non-MIG (PSG) Pathway: 

• Assess and submit OCF-18 treatment plan with full clinical justification 

• Wait for insurer response (typically within 10 business days) 

• Invoice using OCF-21B with itemized CCI/GAP codes 

• PSG hourly rates and limits apply 

 Tips and Notes 

1. Not all Ontario Claims Forms (OCFs) are mandatory for each claimant, depending on their injury and medical needs after an accident. There are, however, two specific forms that are mandatory for each claimant, and without these forms, you will not be paid your invoices. The mandatory forms include the OCF-1 (Application for Accident Benefits) and the OCF-3 (Disability Certificate). 

2. Use the most up-to-date codes for billing. ICD-11 codes are the most recent and should be used to avoid billing delays.   

3. Submit your forms as promptly as possible to avoid approval and payment delays 

Want more resources to help you navigate the auto insurance sector? Let us know by emailing physiomail@opa.on.ca