Ontario Claim Form 10 (OCF-10)
Election of Income Replacement, Non-Earner or Caregiver Benefit

Effective September 1, 2010.

Although you may be eligible for the Income Replacement Benefit, Non-Earner Benefit and/or the Caregiver Benefit, you can only receive one of these weekly income benefits.

You must consult with your legal representative and choose which benefit you wish to receive.

Please note that your choice of benefits cannot be changed after this form has been submitted to the insurance company unless your accident-related injury and impairment is determined to be catastrophic.

Again, if you need help in choosing the benefit, please consult with your legal representative immediately.

If your insurance company has sent you this form and asked you to choose a benefit, then consult with your legal representative, complete the form, and return it to your insurance company no later than 30 days from the day you received it.

Make a copy for your own records.

Please print clearly.

If you want to learn more about the companion accident benefits claim, and kickstarting the accident benefits application process, then please click the “link” to read my blog entitled “How to Get Your Accident Benefits Application Started”.