What the OCF-18 is for
The Treatment and Assessment Plan asks an auto insurer to pay for treatment, assessments, or goods and services for someone injured in a car accident. You propose what is reasonable and necessary for the injuries, and the insurer decides in Part 13 whether to approve all of it, part of it, or none.
Some claims don’t need one: emergency goods and services within five business days of the accident, prescription drugs, dental claims on the dental form, and certain items or services of $250 or less. Injuries within the Minor Injury Guideline go on an OCF-23 instead.
Who completes it
The applicant provides Parts 1 and 2, with their details and the insurer’s. After the plan is reviewed with them, they sign Part 10 and initial Part 12 to confirm consent to the proposed goods and services. A health practitioner signs Part 4. The regulated health professional who prepares and supervises the plan completes Part 5 and the rest, unless they are the same person who signs Part 4.
Often the applicant writes their details on a printed copy at the front desk or gives them over the phone, and someone at the clinic retypes them into the plan. In Medulla, you send Parts 1 and 2 to the patient over a secure link before the visit. They fill them in on the form from any device, and their answers are already on the PDF you complete the clinical parts on.
How to fill in the clinical parts
Part 3, Other Insurance Information
Make reasonable enquiries about other coverage and record any other insurer and plan number. The form notes that from July 1, 2026, auto insurers are the first payor for medical and rehabilitation benefits, though medication expenses still go to supplementary health plans first.
Part 4, Signature of Health Practitioner
The signing practitioner confirms the plan has been reviewed with the applicant and that the goods and services are reasonable and necessary. Answer whether the impairment is predominantly a minor injury. If it is, tick which circumstance applies, either treatment under the guideline is done and more is needed within the $3,500 limit, or a documented pre-existing condition will prevent maximal recovery, and give compelling evidence for the second.
Parts 6 to 8, injuries, prior conditions and activity limitations
List the injuries and sequelae with ICD-10-CA codes, most significant first. Record prior conditions that could affect the response to treatment and any new unrelated condition. Then describe how the impairment limits work and normal life, and whether the employer can offer modified work.
Part 9, goals, evaluation and barriers
Tick the impairment goals, such as pain reduction, range of motion or strength, and the functional goals, such as return to work or normal activities. Say how you will measure progress, and for a subsequent plan, what the applicant gained from the last one. Name barriers to recovery and any concurrent treatment elsewhere.
Parts 11 and 12, providers and goods and services
List each provider who will deliver care. Then list every proposed good or service with its code, attribute, measure, quantity and cost, using the HCAI coding guidelines, along with the plan’s estimated duration and visits already provided.
Common reasons it’s partly approved or denied
- Goals that don’t connect to the injuries in Part 6.
- No evaluation method, or no result reported from a previous plan.
- An injury within the Minor Injury Guideline with no circumstance ticked or no evidence for the pre-existing condition.
- Goods and services without quantities or costs, or totals that don’t reconcile with other coverage.
- No applicant signature in Part 10, unless the insurer waived it.
Submitting and who pays
Return the plan to the insurer in Part 2, and send any attachments directly to the insurer as the form instructs. Clinics registered with HCAI, the electronic system Ontario auto insurers use to exchange claim forms with health care facilities, may submit it through that system. If the applicant starts treatment that needs approval before the insurer decides, they may have to pay for it. The fee for completing the form is billed to the insurer.