A simulated Ontario AB file showing timely intake, form tracking, employment information, treatment-document coordination and customer follow-up.
FileON-AB-2026-0708
LossJuly 8, 2026 · 8:10 a.m.
CustomerDaniel Cho
LocationLondon, Ontario
Fictional training scenario created for portfolio demonstration. It does not represent an actual claimant, customer, employer, insurer, provider or claim.
01 · INTAKE SUMMARY
Reported circumstances
Daniel reports being a passenger in an Ontario automobile collision. He was assessed at a walk-in clinic the following day for discomfort and reports missing scheduled work. He is seeking information about the accident-benefits application process and possible treatment support. The file requires insurer-routing confirmation, completed application information and appropriate health-practitioner documentation before authorized entitlement review.
02 · IMMEDIATE PRIORITIES
First actions
Confirm immediate health and safety needs and encourage appropriate medical attention without diagnosing or directing treatment.
Confirm accident details, insurance relationships and the appropriate insurer-routing information.
Explain the time-sensitive application process, issue the appropriate forms and set clear follow-up dates.
03 · INFORMATION GAPS
What remains missing
Complete OCF-1 applicant, accident and insurance information.
Health-practitioner information and whether an OCF-3 has been requested or completed.
Employer, occupation, work schedule and earnings information relevant to an OCF-2 request.
Treatment provider details and any proposed OCF-18 or other supporting documentation.
Collateral benefits or other available coverage information.
Expenses claimed, receipts, functional concerns and preferred communication method.
04 · INVESTIGATION PLAN
Evidence and purpose
OCF-1 applicationCapture applicant, accident, insurance and benefit-application information.
OCF-3 disability certificateObtain health-practitioner information when requested and relevant.
OCF-2 employer confirmationVerify employment and earnings information where required.
OCF-5 authorizationDocument permission to obtain relevant health information when used.
OCF-18 treatment planRoute proposed treatment information for authorized review.
Expense recordsOrganize claimed expenses and supporting receipts without promising reimbursement.
05 · CHRONOLOGY & DIARY
File development
Collision occurs; passenger information and initial contact details recorded.
AB intake completed; application package and return instructions issued.
Customer confirms clinic assessment and missed work; OCF-3 and employer information discussed.
OCF-2 request coordinated; customer receives status update.
Treatment-plan information received and routed for authorized review.
Outstanding-items review completed; diary dates updated and customer advised of next steps.
06 · CUSTOMER COMMUNICATION
Professional updates
Application explanation
I will explain which information is needed, where the forms should be returned and the follow-up date. Completing a form does not by itself guarantee that a benefit or expense will be approved.
Missing information
Your application has been received. Employer details and the requested health-practitioner information remain outstanding. I can help clarify the administrative requirements, while benefit entitlement will be determined through the authorized review process.
Treatment-plan update
The treatment information has been added to the file and sent for review. I cannot predict the decision, but I will provide a status update by the date noted in the file.
07 · CLOSURE CONTROL
Review checklist
Accident and insurer-routing information documented
OCF-1 reviewed for administrative completeness
Relevant OCF forms tracked
Employment and provider information organized
Customer updates and diary commitments completed
Outstanding items identified or escalated
File summary prepared for authorized entitlement review
Outcome: The application, employment and treatment documentation were organized and the customer received clear updates. The file remained open for authorized benefit and treatment-plan decisions.
08 · WORKLOAD MANAGEMENT
From one file to a managed claims queue
These visuals extend the individual case into a fictional 12-file workload, demonstrating prioritization, outstanding-item control, diary management and operational reporting.
WORKLOAD TRACKER
Fictional claims queue
Tracks claim type, status, priority, customer contact, outstanding information, next action, follow-up date and days open.
All names, file identifiers and workload data shown above are completely fictional and were created solely for portfolio demonstration.
Decision boundary
This work demonstrates intake, investigation planning, documentation, communication and follow-up. Coverage, causation, entitlement, medical necessity, reserve, payment and settlement decisions remain with authorized professionals.
Claims Portfolio
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