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Accident Benefits Referral

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  • Accident Benefits Referral

Accident Benefits Referral

    Insured’s Contact Info (only if ADS can contact)

    Insurer’s Contact Info (for billing)

    General Questions

    Please provide the following documentation. Please indicate explicitly if it is not available.

    • OCF-1, OCF-2, and OCF-3
    • Personal Tax Return, Statement of Business Activities and Notice of Assessment – Last tax year prior to the MVA and all since
    • Corporate Tax Return, Schedules 1, 8, 50, 125 and Notice of Assessment – Last tax year prior to the MVA and all since
    • Statutory Declaration
    • Insurer’s denial of payment / eligibility
    • Any other Financial documents (i.e. pay statements)

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