Important Notice

May 25, 2020

COVID-19 Updates on Tribunals Ontario Operations – Learn More.

Forms and Filing

Changes at the CICB

Please take note of these important changes at the CICB:

  1. Beginning October 1, 2019, the CICB will no longer accept:
    • applications for compensation
    • requests for review hearings
    • applications to vary an order for compensation
  2. Monday, September 30, 2019 was the last day to file an application with the CICB. Applications received after 11:59 p.m. on September 30 will not be accepted.
  3. Beginning October 1, 2019, CICB decisions can no longer be appealed to the Divisional Court.
  4. Beginning October 1, 2019, individuals seeking supports and services that result from being a victim of crime can contact the Ministry of the Attorney General's Victim Quick Response Program + (VQRP+).
  5. CICB awards made on or after May 29, 2019 will be subject to a maximum lump sum payment of $30,000 and a maximum award for pain and suffering of $5,000.

Forms

Applications

As of October 1, 2019, the CICB is no longer accepting applications for compensation.

Notice of Change of Address

Use this form to let us know if your contact information changes while we are processing your application. It's important to keep your phone number and address up to date. If we can't reach you, it will delay your application and could even cause your application to be dismissed.

Send us the form by email, fax or mail. If you are emailing the form, check the box to apply your electronic signature. If you fax or mail the form, remember to sign and date it.

Notice of Legal Representation

Use this form to give your legal representative permission to communicate with the CICB about your case and access the information on your file. If you choose to have a legal representative, the CICB will only communicate with that person and not with you.

Authorization for Authorized Party

Use this form to give someone other than your legal representative permission to communicate with the CICB about your case and access the information on your file.

Direction of Funds

Use this form to tell the CICB that you want your legal representative to receive award money on your behalf.

Consent to Disclose Personal Health Information

The CICB routinely requests medical information in order to assess your injuries. Healthcare providers like doctors and hospitals usually require your written consent before they will share those documents with the CICB. Use this form to give your consent.

Verification Form

Give this form to your treatment provider to submit counselling, physiotherapy, dental, chiropractic or massage therapy treatment expenses for payment. Your treatment provider must attach invoices to the form that show the details of the service provided and the cost. Do not use this form unless you have received written permission from the CICB to submit these expenses in advance. Any expenses you submit that the CICB has not pre-authorized will not be paid.

Litigation Guardian Forms

Use these forms to apply to be a litigation guardian for an applicant is who is under 18 or lacks the mental capacity to make decisions about an application to the CICB. A litigation guardian is responsible for managing the application and making decisions on behalf of the applicant.

Notice of Motion

Use this form when you want to ask the CICB to make an order about any issue in an application.

Request for Summons

Use this form to ask the CICB to issue a summons to require a witness to give oral evidence at a hearing and/or bring certain documents to a hearing.

Request for Reconsideration

Use this form to request a reconsideration of the CICB's final decision in an application heard by two or more members. You have 30 days from the time you receive the CICB's decision to make this request.

Request for Review

As of October 1, 2019, requests for review hearings can no longer be filed with the CICB. For more information, see Latest News.

Application to Vary an Order for Compensation

As of October 1, 2019, applications to vary an order for compensation can no longer be filed with the CICB. For more information, see Latest News.