Revised Designated Assessment Referral and Summary Report Under Bill 59 and Bill 164



No. A-10/98
- Auto
Property & Casualty

To the attention of all insurance companies licensed
to transact automobile insurance in Ontario

With this bulletin, the Financial Services Commission of Ontario (FSCO) is issuing a revised version of a statutory accident benefit form that was issued along with 26 others as part of the implementation of Bill 59, the Automobile Insurance Rate Stability Act, 1996. These forms were attachments to OIC Bulletin No. A-10/96, dated October 23, 1996, issued by the Ontario Insurance Commission (OIC).


The form that has been revised is the "Designated Assessment Referral and Summary Report" form (OCF-11). This form is used for referrals to Designated Assessment Centres (DACs) for accidents occurring under both Bill 59 and the previous system under Bill 164.


Part 3 of the form has been changed to inquire as to whether the referral has been made to the DAC nearest to the claimant’s residence, and if not, the reason for not making the referral to the nearest DAC.

Part 4 of the form has been changed to capture the types of goods and service in dispute that a medical and rehabilitation DAC will assess.


Part 5 of the form has been amended to reflect more accurately the different provision under Bill 59 and Bill 164 for submitting those medical and rehabilitation goods and service in dispute for assessment.

This form has been modified and recommended by the Minister’s Committee on the DAC System.


Insurers that still have supplies of the existing form may continue to use them before acquiring copies of the revised form.


Distinguishing the revised form from the previous version


Specimen copies in English and French, of the revised "Designated Assessment Referral and Summary Report" form (OCF-11) are attached. They may be distinguished from the previous forms by the date code shown at the bottom right corner. The updated date code, as it appears in the English version, is shown as (98-07), referring to year and month respectively. The date code on the earlier version is (96-11).


How to obtain the revised form


  • Bulk orders of this form are available from printers such as:

    Informco Inc.
    35 Bertrand Avenue
    Scarborough ON M1L 2P3
    Phone: (416) 285-1700

    Proprint Forms
    5621 Finch Avenue East
    Unit 5
    Scarborough ON M1B 2T9
    Phone: (416) 754-3028

    Lancaster Datamark
    40 Nolan Court
    Markham ON L3R 2V7
    Phone: (905) 475-9750

  • If you have your own printer and wish to obtain the form on disk, please send your request by facsimile to the attention of the Administrative Officer, Public Affairs, Policy and Communications Branch, FSCO, indicating both the title and the code number of the form you wish to obtain. The fax number is (416) 590-7070.

If you need additional information on this revised form, please contact Sandy Lane in the Accident Benefits Analysis Unit, FSCO, at (416) 590-7137.

Dina Palozzi
Superintendent and
Chief Executive Officer
July 22, 1998



Revised Designated Assessment Referral and Summary Report form

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