Physiotherapists, chiropractors, physicians and other clinicians use this plan to ask an Ontario auto insurer to approve treatment, assessments or goods for injuries outside the Minor Injury Guideline (MIG). A health practitioner certifies the plan, a regulated health professional prepares and supervises it, and the insurer must say within 10 business days which items it will pay for. Approved items are then billed on the OCF-21.
A health practitioner signs Part 4 and the regulated health professional who prepares and supervises the plan signs Part 5; one person can do both. The applicant supplies the information for Parts 1 to 3, signs Part 10 unless the insurer waives it, and initials consent in Part 12.
The applicant supplies these details. Fields marked * are required if known, ** need at least one entry and *** are optional. Enter the claim number, policy number or both, and copy the date of birth, gender and accident date exactly: HCAI matches plans to claims on these five elements, and an insurer may decline and return a form it cannot match. In HCAI, choose the licensed insurer, not an independent adjusting firm.
Confirm that you made reasonable enquiries of the applicant about other coverage for the proposed goods and services, record up to two other insurers, and state whether Ministry of Health (MOH) coverage applies. For accidents in Ontario on or after July 1, 2026, the auto insurer must pay medical and rehabilitation expenses even where a supplementary health plan would cover them; medication expenses still go to those plans first.
The health practitioner certifies that the regulated health professional in Part 5 reviewed the plan with the applicant and that the goods and services are reasonable and necessary for the Part 6 injuries. Add the HCAI Facility Registry Number and FSRA licence number if applicable. For accidents on or after September 1, 2010, answer whether the impairment is predominantly a minor injury; if Yes, select the circumstance, either MIG treatment already given with more needed within the minor injury limit, or a documented pre-existing condition explained with compelling evidence.
The regulated health professional who prepared the plan and will supervise it signs here; if that is the Part 4 practitioner, tick the box and skip this part. In HCAI the Part 4 practitioner can be external, but choosing one makes Part 5 mandatory, and the Part 5 professional must belong to your facility. Signatures are not transmitted electronically: keep the signed paper copy on file, because the insurer or FSRA may ask to see it.
List each complaint, injury and sequela that is a direct result of the accident with its ICD-10-CA code, most significant first and each code once. HCAI asks you to put the main reason for the proposed services first, code each assessment to the complaint that prompted it, list resolved conditions last and code bilateral injuries only once unless they are distinct injuries. HCAI cannot advise on code choice, so ask your professional association.
State whether, before the accident, the applicant had a disease, condition or injury that could affect their response to treatment (No, Unknown or Yes with an explanation), and if Yes, whether it was investigated or treated in the past year, naming the provider if known. Then report any unrelated condition that has developed since the accident. HCAI notes that answering Unknown may prompt the insurer to ask for clarification.
Say whether the impairments affect the applicant's tasks of employment and activities of normal life, then briefly describe the limited activities and their impact on function. If the applicant cannot do their pre-accident work, state whether the employer can provide suitable modified employment. HCAI notes that a No to that question needs an explanation and may lead the insurer to contact the employer.
Tick impairment goals (pain reduction, range of motion, strength or other) and functional goals (return to activities of normal living, pre-accident work or modified work), then explain how progress will be evaluated. For a subsequent plan, report the improvement measured at the end of the previous one. Record barriers to recovery, your strategies for them and any concurrent treatment by another provider. HCAI advises keeping the goals consistent with the services coded in Part 12.
Review the plan with the applicant or substitute decision maker, who signs to consent to the insurer's collection and use of information and to confirm they agree with the plan. The signature is required unless the insurer waives it, and HCAI says such a waiver must be agreed in advance. The applicant also acknowledges that payment depends on insurer approval and that services started before approval may be their own cost.
List each provider (A to F) with provider type, College registration number and hourly rate. In Part 12, enter each good or service with its code, attribute, provider, quantity, measure and cost; HCAI requires CCI or GAP codes, never MIG codes, and measures such as 0.25 HR for 15 minutes. Give the plan's duration in weeks and visits already provided, and have the applicant initial consent. The insurer answers in Part 13: approve, partially approve or do not approve.
Download the current version from the source each time; forms change without notice.
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.
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.
Sources for this guide
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Use the OCF-23 when the impairment is predominantly a minor injury under the Minor Injury Guideline. Use the OCF-18 for care outside the MIG, for a minor injury with a pre-existing condition documented before the accident and backed by compelling evidence, for treatment needed after MIG Block 3, or when MIG services were not provided within the guideline's time frames.
Ten business days. The insurer must send the applicant a notice listing what it will and will not pay for, with medical and other reasons. If it misses that deadline, it cannot later say the Minor Injury Guideline applies and must pay for plan items from the 11th business day until it responds. Approved items are paid within 30 days of an invoice.
Part 4 is signed by a health practitioner (chiropractor, dentist, nurse practitioner, occupational therapist, optometrist, physician, physiotherapist, psychologist or speech-language pathologist) who certifies the plan is reasonable and necessary. Part 5 is signed by the regulated health professional who prepares and supervises it, which can include a massage therapist, nurse or social worker. If one person does both, tick the box and skip Part 5.
For accidents in Ontario on or after July 1, 2026, yes for medical and rehabilitation expenses: the SABS requires the auto insurer to pay even the portion a supplementary health plan, such as workplace benefits, would cover. Medication expenses still go to the supplementary plan first. Part 3 of the OCF-18 still asks about other insurance and Ministry of Health coverage.