With this Bulletin, the Financial Services Commission of Ontario (FSCO) is issuing 14 new or revised forms for Statutory Accident Benefit Claims. The forms reflect changes to the Statutory Accident Benefits Schedule (SABS) to eliminate the Designated Assessment Centre (DAC) system which becomes effective on March 1, 2006. The forms also include revisions to consent language, elimination of same-sex partner references and other housekeeping changes.
Two existing accident benefit claims forms are being dropped and consolidated into other claims forms. In addition, two claims forms that relate specifically to DAC assessments will also be phased out following the run-off of ongoing DAC assessments.
Form 1, Assessment of Attendant Care Needs, is no longer printed as part of the SABS. A revised version of this form with updated hourly rates will be used for accidents on or after March 1, 2006. The revised form is attached and has been posted on FSCO’s website.
Changes to these forms have been made in consultation with the insurance industry, health care professionals, and legal representatives.
For your convenience, an attached chart sets out a list of revised, new and eliminated claims forms.
How to Obtain the New/Revised Forms
Copies of the new and revised forms are attached for your information. The forms are also available on FSCO’s website at: www.fsco.gov.on.ca.
Bob Christie
Chief Executive Officer and
Superintendent of Financial Services
January 31, 2006
Attachments:
- Summary Chart
- OCF-1 Application for Accident Benefits
- OCF-3 Disability Certificate
- OCF-4 Death and Funeral Benefits
- OCF-5 Permission to Disclose Health Information
- OCF-9 Explanation of Benefits
- OCF-12 Activities of Normal Life
- OCF-18 Treatment Plan
- OCF-19 Application for Determination of Catastrophic Impairment
- OCF-21 Auto Insurance Standard Invoice
- OCF-22 Application for Approval of an Assessment or Examination
- OCF-23/198 Pre-Approved Framework Treatment Confirmation Form
- OCF-25 Notice of Examination
- OCF-26 Voluntary Consent for Pre-Claim Examination
- Form 1 Assessment of Attendant Care Needs
Summary Description of Accident Benefit Forms
ACCIDENT BENEFIT CLAIMS FORM |
DESCRIPTION AND APPLICABILITY |
| OCF-1 Application for Accident Benefits |
Revised. Use for accidents on or after November 1, 1996.
|
| OCF-3 Disability Certificate |
Revised. Use for accidents on or after November 1, 1996. |
OCF-4 Death and Funeral Benefits
OCF-5 Permission to Disclose Health Information
|
Revised. Use for accidents on or after January 1, 1994.
Revised. Use for accidents on or after January 1, 1994. |
|
|
OCF-9 Explanation of Benefits |
|
Revised. Use for accidents on or after November 1, 1996. |
OCF-11 Designated Assessment Centre Referral, Plan and Summary Form
|
To be phased out in 2006. |
| OCF-12 Activities of Normal Life |
Revised. Use for accidents on or after November 1, 1996. |
OCF-14 Permission to Disclose Health Information to the Designated Assessment Centre
|
To be phased out in 2006. |
OCF-17 Notice of Stoppage of Weekly Benefits and Request for Assessment
|
Eliminated. Form consolidated into New OCF-25 and revised OCF-9. |
| OCF-18 Treatment Plan |
Revised. Use for accidents on or after November 1, 1996. |
OCF-19 Application for Determination of Catastrophic Impairment
|
Revised. Use for accident on or after November 1, 1996. |
OCF-20 Catastrophic Impairment Determination and Request for Assessment
|
Eliminated. Form consolidated into New OCF-25 and revised OCF-9. |
| OCF-21 Auto Insurance Standard Invoice |
Revised. Use for accidents on or after November 1, 1996. |
OCF-22 Application for Approval of an Assessment or Examination
|
Revised. Use for accidents on or after November 1, 1996. |
OCF-23/198 Pre-Approved Framework Treatment Confirmation Form
|
Revised. Use for accidents on or after October 1, 2003. |
| OCF-25 Notice of Examination |
New. Use for accidents on or after November 1, 1996. |
OCF-26 Voluntary Consent for Pre-Claim Examination
|
New. Use for accidents on or after November 1, 1996. |
| Form 1, Assessment of Attendant Care Needs |
Revised. Use for accidents on or after March 1, 2006. |