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 current versions of the forms. Also included, are the revised forms to be used on or after June 1, 2016. To find an older version visit the archive section.
 
OCF-1: Application for Accident Benefits​  Size: ## kb
  • Effective June 1, 2016 [PDF Document] Size: ## kb PDF Revised
  • Effective November 1, 2014 [PDF Document] Size: ## kb PDF 
  • Effective June 1, 2013 [PDF Document] Size: ## kb PDF
OCF-2: Employer's Confirmation Form  Size: 92 kb
  • Effective June 1, 2016 [PDF Document] Size: ## kb PDF Revised
  • Effective as of December 1, 2004 [PDF Document] Size: ## kb PDF
     
OCF-3: Disability Certificate Size: 130 kb 
  • Effective June 1, 2016 [PDF Document] Size: ## kb PDF Revised
  • Effective September 1, 2010 [PDF Document] Size: ## kb PDF
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 June 1, 2016 [PDF Document] Size: ## kb PDF Revised
  • Effective November 1, 2014 [PDF Document] Size: ## kb PDF
  • 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 June 1, 2016 [PDF Document] Size: ## kb PDF Revised
  • Effective November 1, 2014 [PDF Document] Size: ## kb PDF 
    Note: minor change has been made to the form use date since the original release on August 26, 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 June 1, 2016 [PDF Document] Size: ## kbPDF Revised
  • Effective November 1, 2014 [PDF Document] Size: ## kb PDF 
  • Effective November 1, 2012 [PDF Document] Size: ## kb PDF
 
OCF-24: Minor Injury Treatment Discharge Report  Size: 75 kb
  • Effective June 1, 2016 [PDF Document] Size: ## kb PDF Revised
  • Effective September 1, 2010 [PDF Document] Size: ## kb PDF
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.)​
 
(Effective January 01, 2013)
 
Form 1: Assessment of Attendant Care Needs [PDF Document] Size: 157 kb
(Effective September 1, 2010)​
 

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