Oc 400 form: Fill out & sign online

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Click ‘Get Form’ to open the form representative asserted form in the editor.
Begin by filling in the WCB Case Number and Carrier Case Number at the top of the form. This information is crucial for identifying your case.
Next, enter the Date of Accident, Illness or Injury. Ensure this date is accurate as it relates directly to your claim.
In the Claimant section, provide the Name and Address of the claimant. This identifies who is making the claim.
For the Attorney/Representative Certification section, complete item 1 by certifying that you have reviewed Form C-3 and believe it has evidentiary support. Include your signature, printed name, ID number if applicable, title, and license details.
If you are representing a carrier, complete item 2 similarly by certifying on behalf of the insurance carrier regarding any notice of controversy filed.
Finally, review all entered information for accuracy before submitting. Use our platform’s features to save or share your completed form easily.

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