Forms

For your convenience, auto insurance claim forms are available for download in PDF format:

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-13 – Declaration of Post-Accident Income and Benefits

OCF-18 – Treatment and Assessment Plan

OCF-19 – Application for Determination of Catastrophic Impairment

SDN – Settlement Disclosure Notice