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OPB 3013: Disabled Dependant Medical Report (PSPP)

When an Ontario Pension Board client in the Public Service Pension Plan dies, a dependant with a continuing mental or physical disability that makes them financially dependent may qualify for a survivor pension. This report is how the Ontario Pension Board receives the medical evidence. All the information must describe the dependant's condition up to and including the client's date of death.

Who completes it

The applicant completes page 1, including the deceased client's details, date of death and a signed authorization, before forwarding the form. The dependant's physician completes pages 2 and 3 and strikes out areas that do not apply.

Submitting and payment

How to submit it
The physician returns the completed report to the applicant, who files it with the Ontario Pension Board.
Who pays
The applicant is responsible for paying any fees the physician charges to complete the report.

Good to know

  • A separate form is needed for each disabled dependant, and proof of the client's death must be attached if it has not already been sent to OPB.
  • The physician's assessment certifies three points: a continuing disability at the client's date of death, a disability likely to cause financial dependence, and a condition unlikely to improve.
  • Questions cover when symptoms first appeared, when you started treating the dependant, diagnosis and treatment start date, cause, subjective symptoms, objective findings and prognosis.
  • The signer must be recognized by the appropriate governing medical association in Canada or the USA, for example the Canadian Medical Association or American Medical Association.

Get the official form

Download the current version from the source each time; forms change without notice.

Medical Examination Report for a Disabled Dependant – Public Service Pension Plan (PSPP)

Official pagePDF

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Who qualifies as a disabled dependant under the Ontario PSPP?

The form explains that a disabled dependant must have a continuing mental or physical disability that makes them financially dependent to be eligible for a survivor pension from the Public Service Pension Plan. The physician's report must address the dependant's condition up to and including the OPB client's date of death.

Can a US physician complete OPB 3013?

Yes, if recognized as a physician or medical professional by the appropriate governing medical association in Canada or the USA; the form cites the Canadian Medical Association and the American Medical Association as examples. The signer also indicates whether they are a certified specialist and in which specialty.

What happens if the medical report is not provided?

The applicant's signed authorization on page 1 acknowledges that without the medical information, the dependant may not qualify for a survivor pension. OPB receives, uses and keeps the information solely to evaluate the survivor benefit application, according to the authorization on the form.