Revised Statutory Accident Benefits Claims Forms



No. A- 12/04
– 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 number of amended forms approved by the Superintendent for use in connection with statutory accident benefits claims.


These forms have been amended to reflect Bill 31, the Personal Health Information Protection Act, 2004, which came into force on November 1, 2004.


Changes to these forms have been made in consultation with the insurance industry, health professionals and other stakeholders. Revisions also include form improvements requested by these stakeholders.



Use of the Forms


The amended forms are to be put into use in place of any previous versions effective immediately, and in any event by no later than November 15, 2004. The amended forms apply to accidents occurring both before and after November 1, 2004.


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.



How to obtain the revised/new forms


Specimen copies of the amended forms are attached to this Bulletin. You can also access the forms at FSCO’s website at:

Bryan P. Davies
Chief Executive Officer and
Superintendent of Financial Services

November 8, 2004




OCF-1 [PDF Document] Size: 362 kb, OCF-2 [PDF Document] Size: 173 kb, OCF-3 [PDF Document] Size: 310 kb, OCF-4 [PDF Document] Size: 163 kb, OCF-5 [PDF Document] Size: 129 kb, OCF-6 [PDF Document] Size: 91 kb, OCF-9 [PDF Document] Size: 186 kb, OCF-10 [PDF Document] Size: 79 kb, OCF-11 [PDF Document] Size: 427 kb, OCF-12 [PDF Document] Size: 143 kb, OCF-13 [PDF Document] Size: 159 kb, OCF-14 [PDF Document] Size: 100 kb, OCF-17 [PDF Document] Size: 161 kb, OCF-18 [PDF Document] Size: 337 kb, OCF-19 [PDF Document] Size: 175 kb, OCF-20 [PDF Document] Size: 113 kb, OCF-21 [PDF Document] Size: 686 kb, OCF-22 [PDF Document] Size: 448 kb, OCF-23 [PDF Document] Size: 287 kb, OCF-24 [PDF Document] Size: 209 kb

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