The revised Assessment of Attendant Care Needs (Form 1) is also available below.
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.
** Please note: All forms effective September 1, 2010 are fillable and saveable. **
OCF-1: Application for Accident Benefits
- Effective as of September 1, 2010 (PDF)*
- Effective as of May 1, 2007 (PDF)*
- Effective as of March 1, 2006 (PDF) (MS Word)
- Effective as of December 1, 2004 (PDF)
OCF-2: Employer's Confirmation Form
- Effective as of December 1, 2004 (PDF)
OCF-3: Disability Certificate
- Effective as of September 1, 2010 (PDF)*
- Effective as of May 1, 2007 (PDF) (MS Word)
- Effective as of March 1, 2006 (PDF) (MS Word)
- Effective as of December 1, 2004 (PDF)
OCF-4: Death and Funeral Benefits Application
OCF-5: Permission to Disclose Health Information
- Effective as of September 1, 2010 (PDF)*
- Effective as of May 1, 2007 (PDF) (MS Word)
- Effective as of March 1, 2006 (PDF) (MS Word)
- Effective as of December 1, 2004 (PDF)
OCF-6: Expenses Claim Form
OCF-9: Explanation of Benefits Payable by Insurance Company
OCF-10: Election of Income Replacement, Non-Earner or Caregiver Benefit
OCF-11: Designated Assessment Centre Referral, Plan and Summary Form
- No longer in use.
OCF-12: Activities of Normal Life
OCF-13: Declaration of Post-Accident Income and Benefits
- Effective as of December 1, 2004 (PDF)*
OCF-14: Permission to Disclose Health Information to the Designated Assessment Centre
- No longer in use.
OCF-17: Notice of Stoppage of Weekly Benefits and Request for Assessment
- Discontinued as of March 1, 2006.
OCF-18: Treatment and Assessment Plan
- Effective as of September 1, 2010 (PDF)*
- Effective as of January 7, 2008 (PDF) *
- Effective as of May 1, 2007 (PDF) (MS Word)
- Effective as of March 1, 2006 (PDF) (MS Word)
- Effective as of December 1, 2004 (PDF)
OCF-19: Application for Determination of Catastrophic Impairment
- Effective as of September 1, 2010 (PDF)*
- Effective as of May 1, 2007 (PDF) (MS Word)
- Effective as of March 1, 2006 (PDF) (MS Word)
- Effective as of December 1, 2004 (PDF)
OCF-20: Catastrophic Impairment Determination and Request for Assessment
- Discontinued as of March 1, 2006.
OCF-21: Auto Insurance Standard Invoice
- Effective as of September 1, 2010 (PDF)*
- Effective as of January 7, 2008 (PDF)*
- Effective as of April 2, 2007 (PDF)
- Effective as of March 1, 2006 (PDF) (MS Word)
- Effective as of December 1, 2004 (PDF)
OCF-22: Application for Approval of an Assessment or Examination
NB: Discontinued as of September 1, 2010.- Effective as of January 7, 2008 (PDF)*
- Effective as of May 1, 2007 (PDF) (MS Word)
- Effective as of March 1, 2006 (PDF)
- Effective as of December 1, 2004 (PDF)
OCF-23: Treatment Confirmation Form
- Effective as of September 1, 2010 (PDF)*
- Effective as of January 7, 2008 (PDF)
- Effective as of March 1, 2006 (PDF) (MS Word)
- Effective as of December 1, 2004 (PDF)
OCF-24: Minor Injury Treatment Discharge Report
- Effective as of September 1, 2010 (PDF)*
- Effective as of October 1, 2007 (PDF)
- Effective as of December 1, 2004 (PDF)
OCF-25: Notice of Examination
- Effective as of March 1, 2006 (PDF)* (Fillable MS Word)
OCF-26: Voluntary Consent for Pre-Claim Examination
Settlement Disclosure Notice
Form 1: Assessment of Attendant Care Needs
- On and after September 1, 2010, use this form for accidents occurring on or after March 31, 2008 (PDF)
- Until August 31, 2010, use this form for accidents occurring on or after March 31, 2008 (PDF)*
- Use this form for accidents occurring on or after February 1, 2007 and before March 31, 2008 (PDF) (MS Word)
- Use this form for accidents occurring on or after March 1, 2006 and before February 1, 2007 (PDF) (MS Word)
- Use this form for accidents occurring on or after October 1, 2003 and before March 1, 2006 (PDF)
* Please Note: In order to make use of the "SAVE" feature, Adobe Acrobat® Reader version 7.0 or higher must be installed.