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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 most recent versions of the forms. To find an older version visit the archive section.
 
  

OCF-1: Application for Accident Benefits [PDF Document] Size: 377kb 
(Effective as of July 1, 2011)

 

OCF-2: Employer's Confirmation Form [PDF Document] Size: 92 kb
(Effective as of December 1, 2004)
 
OCF-3: Disability Certificate [PDF Document] Size: 130 kb 
(Effective September 1, 2010)
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 [PDF Document] Size: 145 kb 
(Effective September 1, 2010)
 
OCF-19: Application for Determination of Catastrophic Impairment [PDF Document] Size: 67 kb
(Effective September 1, 2010)
OCF-21: Auto Insurance Standard Invoice [PDF Document] Size: 197 kb 
(Effective September 1, 2010)
 
(Discontinued as of September 1, 2010.)
 
(Effective September 1, 2010)
 
OCF-24: Minor Injury Treatment Discharge Report [PDF Document] Size: 75 kb
(Effective September 1, 2010)
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.)
Settlement Disclosure Notice [PDF Document] Size: 353 kb
(Effective July 1, 2011)
 
Form 1: Assessment of Attendant Care Needs [PDF Document] Size: 157 kb
(Effective September 1, 2010)​