Settlement Forms



No. A-01/02
- Auto
Property & Casualy
[To the attention of all insurance companies licensed
to transact automobile insurance in Ontario]
Attached are three Settlement Disclosure Notice forms required for use in the final settlement of statutory accident benefits claims under Bill 59, Bill 164 and Bill 68.


These forms follow the release of Bulletin A-11/01 on December 28, 2001, which announced amendments to Ontario Regulation 664, relating to the settlement of statutory accident benefit claims.


The forms are required to be used for settlements made on or after March 1, 2002, the effective date of the amended regulation.





The Settlement Disclosure Notice forms are approved and required for use under the authority of section 121.2 (1) of the Insurance Act.



Copies of the forms


Copies of these forms are attached and are available at the Financial Services Commission of Ontario website:


Philip Howell
Chief Executive Officer and
Superintendent of Financial Services (Acting)
February 7, 2002


Attachments (PDF):

1. Settlement Disclosure Notice - Bill 59
2. Settlement Disclosure Notice - Bill 164
3. Settlement Disclosure Notice - Bill 68

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