Forms

CPP Disability Application Forms

Application for Canada Pension Plan Disability Benefits

Automobile Accident Benefit Forms

Application for Accident Benefits (OCF-1)

Fill out this form when you are applying for benefits for the first time as a result of an accident. Completing this form is the first step in an accident benefits application.

Effective as of June 1, 2016 (PDF)

Employer’s Confirmation of Income (OCF-2)

Please give a copy of this form to each of your employers over the past 52 weeks. This form is required if you are applying for income replacement benefits.

Effective as of June 1, 2016 (PDF)

Disability Certificate (OCF-3)

This important form is required as part of your initial application. It tells the insurance company about your injuries. Please fill out the first section and give this form to your health practitioner (chiropractor, dentist, occupational therapist, nurse practitioner, optometrist, physician, physiotherapist, occupational therapist, speech language pathologist or psychologist).

Effective as of June 1, 2016 (PDF)

Death and Funeral Benefits Application (OCF-4)

If the insured is deceased as a result of an accident, certain family members may be entitled to death benefits. In addition, up to $6,000 may be provided by the insurer to cover funeral costs.

Download Fillable (MS Word)

Download (PDF)

Application for Expenses (OCF-6)

You can apply for reimbursement of expenses incurred as a result of the accident and not covered under another plan. These include the costs of medical and rehabilitation treatment, lost educational expenses, caregiver, attendant care and household services, transportation expenses, expenses of visitors, and the cost to repair or replace lost or damaged clothing, hearing aids, etc. Please attach all bills and receipts.

Effective as of September 1, 2010 (PDF)

Treatment and Assessment Plan (OCF-18)

This form is used to assess the level of treatment that you require. Parts 1 and 2 must be completed by you; your health professional/practitioner or social worker will complete the remainder of the form.

Effective as of October 1, 2016 (PDF)

Application for Determination of Catastrophic Impairment (OCF-19)

This form must be completed in full and submitted to your auto insurer if you wish to establish that you have suffered a catastrophic impairment as a result of your motor vehicle accident. Persons determined to have a catastrophic impairment are entitled to request extended medical, rehabilitation and/or attendant care benefits and other expenses. On the basis of this Application, your insurer may designate you as catastrophically impaired.

Effective as of June 1, 2016 (PDF)

Treatment Confirmation Form (OCF-23)

Effective as of October 1, 2016 (PDF)

Minor Injury Treatment Discharge Report (OCF-24)

Effective as of June 1, 2016 (PDF)

Assessment of Attendant Care Needs (Form 1)

Use this form to report the future needs for attendant care required by the applicant as a result of an automobile accident that occurs on or after February 1, 2007. This form must be completed by a member of a health profession who is authorized by law to treat the person’s impairment (in this form referred to as a regulated health professional).

Effective for Accidents as of October 1, 2016 (PDF)

Effective for Accidents as of March 31, 2008 (PDF)

Effective for Accidents as of February 1, 2007 (PDF) (MS Word)