Example: air traffic controller

Disability Certificate Ocf 3

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Application for Accident Benefits (OCF-1) - Ontario

Application for Accident Benefits (OCF-1) - Ontario

www.fsco.gov.on.ca

Disability Certificate (OCF-3) If the insurance company asks you to, please fill out the first section and give this form to your health practitioner (chiropractor, dentist, occupational therapist, nurse practitioner, optometrist, physician, physiotherapist, speech-language pathologist or psychologist). This form is completed by you or your

  Benefits, Certificate, Accident, Disability, Accident benefits, Disability certificate, Ocf 3

Disability Certificate (OCF-3) - Ontario

Disability Certificate (OCF-3) - Ontario

www.fsco.gov.on.ca

OCF-3 Page 4 of 5 If you responded ‘Yes’ to any disability test above, what is the anticipated duration? 1-4 weeks 5-8 weeks 9-12 weeks more than 12 weeks If you responded Anticipated Duration ‘more than 12 weeks’ to any disability test above, please explain why the task/activity limitations are likely to persist beyond 12 weeks.

  Certificate, Disability, Disability certificate, Ocf 3

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