Amendments to Accident Benefit Forms - Application for Determination of Catastrophic Impairment (OCF-19) and Standard Benefit Statement

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​​​​​This Bulletin highlights a number of changes and updates to two forms approved by the Superintendent for use in connection with accident benefit claims. These forms have been amended primarily to reflect changes resulting from automobile insurance reforms that are effective June 1, 2016. These new forms are to be used on or after June 1, 2016.

Amendments to these forms are based on filed regulation amendments to the Statutory Accident Benefits Schedule - Effective September 1, 2010 and have been made in consultation with various industry representatives.

The following forms have been revised:

• Application for Determination of Catastrophic Impairment (OCF-19), and
• Standard Benefit Statement.

Highlights of Changes

 
Changes to these forms include, but are not limited to, the following: 
 

• The revised Standard Benefit Statement reflects and aligns with the upcoming automobile insurance regulatory changes.
• The revised OCF-19 includes the new "Catastrophic Impairment" criteria and an Appendix summarizing each criterion in more detail.

The Financial Services Commission of Ontario (FSCO) expects to release the revised Settlement Disclosure Notice later this month. 
 

Effective Date of the Forms

 
The revised Standard Benefit Statement is to be used for medical, rehabilitation and attendant care claims arising from insurance policies issued on or after June 1, 2016.

The revised OCF-19 is to be used for all accidents that occur on or after June 1, 2016.

 

Application of Current and Revised Standard Benefit Statements

 
For a period of time after June 1, 2016, there will be two versions of the Standard Benefit Statement (SBS) in use. The current SBS form (identified at the bottom of the form as FSCO 1293E.2) is used for claims arising from insurance policies issued or renewed before June 1, 2016 and until those claims are closed. The revised SBS form (identified at the bottom of the form as FSCO 1332E) is used for claims arising from auto policies issued or renewed on or after June 1, 2016.
 

How to Obtain the Revised Forms

Copies of the revised OCF-19 and Standard Benefit Statement are included as attachments to this Bulletin, and are also available on FSCO's website at: www.fsco.gov.on.ca.   
 

Brian Mills
Chief Executive Officer and
Superintendent of Financial Services

March 11, 2016

Attachments

 

• Application for Determination of Catastrophic Impairment (OCF-19) - (Use this form for accidents that occur on or after June 1, 2016)
• Standard Benefit Statement - (Use this form for claims arising from insurance policies issued on or after June 1, 2016)