Auto Insurance Claims Forms (OCF Forms)

 

Archived Content

The following content was archived and is provided for historical reference. Information is subject to change and may no longer be accurate.

 

 

OCF-1: Application for Accident Benefits Form

  • Effective as of July 1, 2011 (PDF) [PDF Document] Size: ## kb
  • Effective as of September 1, 2010 (PDF) [PDF Document] Size: 318 kb
  • Effective as of May 1, 2007 (PDF) [PDF Document] Size: 304 kb
  • Effective as of March 1, 2006 (PDF) [PDF Document] Size: 75 kb
  • Effective as of December 1, 2004 (PDF[PDF Document] Size: 126 kb

 OCF-3: Disability Certificate

  • Effective as of May 1, 2007 (PDF) [PDF Document] Size: 53 kb
  • Effective as of March 1, 2006 (PDF) [PDF Document] Size: 56 kb
  • Effective as of December 1, 2004 (PDF) [PDF Document] Size: 143 kb

OCF-4: Death and Funeral Benefits Application

  • Effective as of December 1, 2004 (PDF) [PDF Document] Size: 94 kb

OCF-5: Permission to Disclose Health Information

  • Effective as of May 1, 2007 (PDF) [PDF Document] Size: 23 kb
  • Effective as of March 1, 2006 (PDF) [PDF Document] Size: 24 kb
  • Effective as of December 1, 2004 (PDF) [PDF Document] Size: 76 kb

OCF-6: Expenses Claim Form

  • Effective as of December 1, 2004 (PDF) [PDF Document] Size: 98 kb

OCF-9: Explanation of Benefits Payable by Insurance Company 

NB: Discontinued as of September 1, 2010. 

  • Effective as of December 1, 2004 (PDF) [PDF Document] Size: 83 kb

OCF-10: Election of Income Replacement, Non-Earner or Caregiver Benefit

  • Effective as of December 1, 2004 (PDF) [PDF Document] Size: 84 kb

OCF-12: Activities of Normal Life

NB: Discontinued as of September 1, 2010.

  • Effective as of November 1, 1996 (PDF) [PDF Document] Size: 103 kb

OCF-18: Treatment and Assessment Plan

  • Effective September 1, 2010 (PDF) [PDF Document] Size: 145 kb
  • Effective as of January 7, 2008 (PDF) [PDF Document] Size: 177 kb
  • Effective as of May 1, 2007 (PDF) [PDF Document] Size: 93 kb
  • Effective as of March 1, 2006 (PDF) [PDF Document] Size: 89 kb
  • Effective as of December 1, 2004 (PDF) [PDF Document] Size: 157 kb

OCF-19: Application for Determination of Catastrophic Impairment

  • Effective as of May 1, 2007 (PDF) [PDF Document] Size: 38 kb
  • Effective as of March 1, 2006 (PDF) [PDF Document] Size: 43 kb
  • Effective as of December 1, 2004 (PDF) [PDF Document] Size: 94 kb

OCF-21: Auto Insurance Standard Invoice

  • Effective September 1, 2010 (PDF) [PDF Document] Size: 197 kb
  • Effective as of January 7, 2008 (PDF) [PDF Document] Size: 230 kb
  • Effective as of April 2, 2007 (PDF) [PDF Document] Size: 104 kb
  • Effective as of March 1, 2006 (PDF) [PDF Document] Size: 118 kb
  • Effective as of December 1, 2004 (PDF[PDF Document] Size: 189 kb

OCF-22: Application for Approval of an Assessment or Examination

NB: Discontinued as of September 1, 2010.

  • Effective as of May 1, 2007 (PDF) [PDF Document] Size: 90 kb
  • Effective as of March 1, 2006 (PDF) [PDF Document] Size: 78 kb
  • Effective as of December 1, 2004 (PDF) [PDF Document] Size: 157 kb

OCF-23: Treatment Confirmation Form

  • Effective September 1, 2010 (PDF) [PDF Document] Size: 155 kb
  • Effective as of January 7, 2008 (PDF) [PDF Document] Size: 66 kb
  • Effective as of March 1, 2006 (PDF) [PDF Document] Size: 68 kb
  • Effective as of December 1, 2004 (PDF) [PDF Document] Size: 147 kb

OCF-24: Minor Injury Treatment Discharge Report  

  • Effective as of October 1, 2007 (PDF) [PDF Document] Size: 72 kb
  • Effective as of December 1, 2004 (PDF) [PDF Document] Size: 126 kb

Settlement Disclosure Notice

  • Effective as of September 1, 2010 (PDF) [PDF Document] Size: 49 kb
  • Effective as of October 1, 2003 (PDF) [PDF Document] Size: 91 kb
  • Final Settlement of a Statutory Accident Benefits Claim - Bill 164 (PDF) [PDF Document] Size: 24 kb
  • Final Settlement of a Statutory Accident Benefits Claim - Bill 68 (PDF) [PDF Document] Size: 22 kb

Form 1: Assessment of Attendant Care Needs

  • Until August 31, 2010, use this form for accidents occurring on or after March 31, 2008 (PDF) [PDF Document] Size: 184 kb
  • Use this form for accidents occurring on or after February 1, 2007 and before March 31, 2008 (PDF) [PDF Document] Size: 144 kb
  • Use this form for accidents occurring on or after March 1, 2006 and before February 1, 2007 (PDF) [PDF Document] Size: 176 kb
  • Use this form for accidents occurring on or after October 1, 2003 and before March 1, 2006 (PDF[PDF Document] Size: 269 kb


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