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Auto Insurance Claims Forms (OCF Forms)

Please note that pursuant to Regulation 7/00 (Unfair or Deceptive Acts or Practices), the use of a document in place of a form approved by the Superintendent constitutes an unfair or deceptive act or practice unless none of the deviations in the document affects the substance or is calculated to mislead.
 
Below are the most recent versions of the forms. To find an older version visit the archive section.
 
OCF-1: Application for Accident Benefits​  Size: ## kb
  • Effective November 1, 2014 [PDF Document] Size: ## kb PDF[HTML Document] Size: ## kb Accessible document (Available November 1, 2014)
  • Effective June 1, 2013 [PDF Document] Size: ## kb PDF
OCF-2: Employer's Confirmation Form [PDF Document] Size: 92 kb
(Effective as of December 1, 2004)
 
OCF-3: Disability Certificate [PDF Document] Size: 130 kb 
(Effective September 1, 2010)
OCF-4: Death and Funeral Benefits Application [PDF Document] Size: 81 kb
(Effective March 1, 2006)
OCF-5: Permission to Disclose Health Information [PDF Document] Size: 35 kb
(Effective September 1, 2010)
 
OCF-6: Expenses Claim Form ​​[PDF Document] Size: 42 kbOFC6
(Effective September 1, 2010)
 
OCF-9: Explanation of Benefits Payable by Insurance Company [PDF Document] Size: 46 kb
(Effective March 1, 2006)
(Discontinued as of September 1, 2010.)
OCF-12: Activities of Normal Life [PDF Document] Size: 79 kb
(Effective March 1, 2006)
(Discontinued as of September 1, 2010.)
OCF-13: Declaration of Post-Accident Income and Benefits [PDF Document] Size: 77 kb
(Effective as of December 1, 2004) 
(Discontinued as of September 1, 2010.)
 
OCF-18: Treatment and Assessment Plan   Size: 212 kb
  • Effective November 1, 2014 PDF | Accessible document (Available November 1, 2014)
  • Effective February 1, 2014 [PDF Document] Size: ## kb PDF  | [HTML Document] Size: ## kb Accessible document 
 
OCF-19: Application for Determination of Catastrophic Impairment [PDF Document] Size: 67 kb
(Effective September 1, 2010)
OCF-21: Auto Insurance Standard Invoice  Size: 371 kb
  • Effective November 1, 2014 [PDF Document] Size: ## kb PDF[HTML Document] Size: ## kb Accessible document (Available November 1, 2014)
  • Effective November 1, 2012 [PDF Document] Size: ## kb PDF
(Discontinued as of September 1, 2010.)
 
OCF-23: Treatment Confirmation Form   Size: 156 kb
  • Effective November 1, 2014 [PDF Document] Size: ## kb PDF | [HTML Document] Size: ## kb Accessible document (Available November 1, 2014)
  • Effective November 1, 2012 [PDF Document] Size: ## kb PDF
 
OCF-24: Minor Injury Treatment Discharge Report [PDF Document] Size: 75 kb
(Effective September 1, 2010)
OCF-25: Notice of Examination [PDF Document] Size: 73 kb
(Effective March 1, 2006)
(Discontinued as of September 1, 2010.)
OCF-26: Voluntary Consent for Pre-Claim Examination [PDF Document] Size: 27 kb
(Effective March 1, 2006)
(Discontinued as of September 1, 2010.)
Settlement Disclosure Notice [PDF Document] Size: 353 kb
(Effective July 1, 2011 to December 31, 2012.)
 
(Effective January 01, 2013) 
Form 1: Assessment of Attendant Care Needs [PDF Document] Size: 157 kb
(Effective September 1, 2010)​
 
OutageService Disruption Notice: Please note that due to scheduled maintenance, Licensing Link (Mortgage and Insurance) and the Service Provider Licensing Application will be unavailable between 6:00am to Noon on Sunday, October 5, 2014.
 
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