All cheques are now payable to Financial Services Regulatory Authority of Ontario or FSRA.


Please note that by law, you must use the following forms only. According to Regulation 7/00 (Unfair or Deceptive Acts or Practices), using any document other than those approved by the CEO is considered a deceptive practice or act. The only exception is if nothing in the substitute document affects the policy, or has been calculated to mislead a client.

Current forms

If you need a document that is not listed here, please contact us at [email protected].

OCF-1: Application for Accident Benefits​

OCF-2: Employer's Confirmation Form

OCF-3: Disability Certificate

OCF-4: Death and Funeral Benefits Application

OCF-5: Permission to Disclose Health Information

OCF-6: Expenses Claim Form

OCF-10: Election of Income Replacement, Non-Earner or Caregiver Benefit

OCF-18: Treatment and Assessment Plan

OCF-19: Application for Determination of Catastrophic Impairment

OCF-21: Auto Insurance Standard Invoice

OCF-23: Treatment Confirmation Form

OCF-24: Minor Injury Treatment Discharge Report

Settlement Disclosure Notice

Form 1: Assessment of Attendant Care Needs