jswizzle3737/ontario_laws_and_regs huggingface dataset:
30 (1) Where, as the result of the negligence or other wrongful act or omission of another, an insured person suffers personal injuries for which he or she receives insured services under this Act, the Plan is subrogated to any right of the insured person to recover the cost incurred for past insured services and the cost that will probably be incurred for future insured services, and the General Manager may bring action in the name of the Plan or in the name of that person for the recovery of such costs. Payment by Plan recoverable by insured (2) For the purposes of subsection (1), the payment by the Plan for insured services shall not be construed to affect the right of the insured person to recover the amounts so paid in the same manner as if such amounts are paid or to be paid by the insured person. Cost of hospital services (3) For the purposes of this section, the cost of insured services rendered to an insured person in or by a hospital or health facility shall be at the rate charged by the hospital or health facility to a person who is not an insured person.  R.S.O. 1990, c. H.6, s. 30 (1-3). Exception (4) Despite subsection (1), the Plan is not subrogated to the rights of an insured person in respect of personal injuries arising directly or indirectly from the use or operation, after the 21st day of June, 1990 and before the day section 267.1 of the Insurance Act
comes into force, of an automobile in Canada, the United States of America or any other jurisdiction designated in the Statutory Accident Benefits Schedule under the Insurance Act.  1993, c. 10, s. 53. Exception (5) Despite subsection (1), the Plan is not subrogated to the rights of the insured person, as against a person who is insured under a motor vehicle liability policy issued in Ontario, in respect of personal injuries arising directly or indirectly from the use or operation, after section 29 of the Automobile Insurance Rate Stability Act, 1996 comes into force, of an automobile in Ontario or in any other jurisdiction designated in the Statutory Accident Benefits Schedule under the Insurance Act. Definition (6) In subsection (5), “motor vehicle liability policy” has the same meaning as in the Insurance Act.  1996, c. 21, s. 51. Section Amendments with date in force (d/m/y) 1993, c. 10, s. 53 - 1/01/1994; 1996, c. 21, s. 51 - 1/11/1996
31 (1) Any person who commences an action to recover for loss or damages arising out of the negligence or other wrongful act of a third party, to which the injury or disability in respect of which insured services have been provided is related shall, unless otherwise advised in writing by the General Manager, include a claim on behalf of the Plan for the cost of the insured services.  R.S.O. 1990, c. H.6, s. 31 (1). Recovery paid to Ontario (2) Where a person recovers a sum in respect of the cost of insured services, the person shall forthwith pay the sum recovered to the Minister of Finance.  R.S.O. 1990, c. H.6, s. 31 (2); 2006, c. 19, Sched. L, s. 11 (5). Section Amendments with date in force (d/m/y) 2006, c. 19, Sched. L, s. 11 (5) - 22/06/2006
32 The Plan is not an insurer within the meaning of the Insurance Act, as referred to in section 22 of the Motor Vehicle Accident Claims Act, and may be awarded payment from the Motor Vehicle Accident Claims Fund.  R.S.O. 1990, c. H.6, s. 32.
33 The judge at trial shall, if the evidence permits, apportion the elements of the injured person’s loss and damages so as to clearly designate the amount of the Plan’s recovery for the past cost of insured services and separate it from the amount of the Plan’s recovery of future cost of insured services, if any.  R.S.O. 1990, c. H.6, s. 33.
34 No release or settlement of a claim for damages for personal injuries in a case where the injured person has received insured services under this Act shall be binding on the Plan unless the General Manager has approved the release or settlement.  R.S.O. 1990, c. H.6, s. 34.
35 A liability insurer shall notify the General Manager of negotiations for settlement of any claim for damages including insured services and may pay to the Minister of Finance any amount referable to a claim for recovery of the cost of insured services and such payment discharges the obligation of the liability insurer to pay that amount to the insured person.  R.S.O. 1990, c. H.6, s. 35; 2006, c. 19, Sched. L, s. 11 (5). Section Amendments with date in force (d/m/y) 2006, c. 19, Sched. L, s. 11 (5) - 22/06/2006
36 Where a judgment or settlement includes future cost of insured services, the Plan shall provide the future insured services included in the judgment or settlement.  R.S.O. 1990, c. H.6, s. 36. Direct Recovery
36.0.1 (1) If the Plan has paid for insured services as a result of the negligence or other wrongful act or omission of a person, the Plan has a right, independent of its subrogated right under subsections 30 (1) and 46 (5), to recover, directly against that person, the costs for insured services that have been incurred in the past and that will probably be incurred in the future as a result of the negligence or the wrongful act or omission. Action (2) The General Manager may bring an action in the name of the Plan or the Minister may bring an action in his or her own name for recovery of the costs referred to in subsection (1). Exception (3) The Plan shall not recover costs under this section, (a) against a physician if the negligence or wrongful act or omission of the physician occurred while the physician was acting within the scope of his or her practice and in such circumstances as may be prescribed; (b) against a hospital under the Public Hospitals Act or a laboratory under the Laboratory and Specimen Collection Centre Licensing Act if the negligence or wrongful act or omission upon which the action is based occurred in the course of providing services that the hospital is approved to provide, or that the laboratory is licensed to provide, as the case may be, and in such circumstances as may be prescribed; or (c) against such other persons or entities as may be prescribed in such circumstances as may be prescribed. Preservation of rights of insured persons (4) An action under this section shall not prevent an insured person from recovering the cost or damages to which the person would otherwise be entitled. Cost of hospital services (5) For the purposes of this section, the cost of insured services rendered in or by a hospital or health facility shall be at the rate charged by the hospital or health facility to persons who are not insured. Disclosure of information (6) To the extent that any information relating to insured services is produced in a proceeding under this section, the information shall be produced in a manner that protects the identity of the insured person and of the provider of insured services.  1999, c. 10, s. 1. Section Amendments with date in force (d/m/y) 1999, c. 10, s. 1 - 05/01/2000 Third Party Services
36.1 (1) For the purposes of this section and sections 36.2 to 36.4, a third party service is a service that, (a) is provided by a service provider in connection or partly in connection with, (i) a request or requirement, made by a person or entity, that information or documentation relating to an insured person be provided, or (ii) a request or requirement, made by a person or entity, that an insured person obtain a service from a service provider; (b) is not an insured service or is deemed, by a regulation made under clause 45 (1) (i), not to be an insured service; and (c) is prescribed as a third party service or is prescribed as a third party service in circumstances specified in the regulation. 1993, c. 32, s. 2 (7). Third party (2) For the purposes of this section and sections 36.2 to 36.4, a third party is a person or entity who makes a request or requirement referred to in clause (1) (a). 1993, c. 32, s. 2 (7). Service provider (3) For the purposes of this section and sections 36.2 to 36.4, a service provider is a physician, practitioner, hospital or health facility, or an integrated community health services centre within the meaning of the Integrated Community Health Services Centres Act, 2023. 1993, c. 32, s. 2 (7); 2023, c. 4, Sched. 1, s. 71 (5). Regulations re third parties (4) Despite subsection (2), a regulation may be made, in relation to a specified third party service or in relation to a third party service provided in specified circumstances, (a) prescribing another person or entity as a third party instead of or in addition to the person or entity who makes the request or requirement referred to in clause (1) (a); (b) if more than one person or entity make the request or requirement referred to in clause (1) (a), prescribing one or more of them as third parties and providing that the others are not third parties; or (c) providing that there is no third party. 1993, c. 32, s. 2 (7). Deemed requirement or request (5) For the purpose of subsection (1), a person or entity shall be deemed to have required or requested that information or a document relating to the insured person be provided, or that the insured person obtain a service from a service provider, if providing the information or document or obtaining the service is related to the person or entity doing or not doing anything in relation to the insured person or related to the insured person receiving or not receiving anything from the third party. 1993, c. 32, s. 2 (7). Section Amendments with date in force (d/m/y) 1993, c. 32, s. 2 (7) - 14/12/1993 2017, c. 25, Sched. 9, s. 97 (7) - no effect - see 2023, c. 4, Sched. 1, s. 67 2023, c. 4, Sched. 1, s. 71 (5) - 25/09/2023
36.2 (1) If a service provider who provides a third party service to an insured person renders an account for payment to the third party, the third party is liable for payment of the account, subject to subsection 36.3 (3). Same (2) If an insured person pays all or part of an account rendered to him or her by a service provider for a third party service provided to the insured person, the third party is liable to reimburse the insured person for the amount paid, subject to subsection 36.3 (4). Insured person’s liability to pay (3) Nothing in this section affects any liability of an insured person to pay a service provider’s account for a third party service. Right to render account at time of service (4) Nothing in sections 36.1 to 36.4 affects any right of a service provider to render an account for a third party service at the time the service is rendered. No double recovery (5) The total amount that the service provider recovers in respect of a third party service shall not exceed the amount of the account rendered.  1993, c. 32, s. 2 (7). Section Amendments with date in force (d/m/y) 1993, c. 32, s. 2 (7) - 14/12/1993 Amounts owing by third parties
36.3 (1) This section applies to, (a) an amount owing by a third party to a service provider under subsection 36.2 (1); (b) an amount owing by a third party to an insured person under subsection 36.2 (2); and (c) an amount owing by an insured person to a service provider for a third party service provided to the insured person by the service provider. Proceeding to recover payment (2) An amount referred to in subsection (1) may be recovered in a court proceeding or, if a body is designated or established under clause 45 (1.1) (f), in a proceeding before the body. Court, body may reduce amount payable (3) In a proceeding to recover an amount referred to in clause (1) (a) or (c), the court or body, in addition to any other order it may make, may order the third party or the insured person, as the case may be, to pay the service provider an amount that is less than the amount charged by the service provider for the third party service if the court or body finds that the amount charged by the service provider for the third party service is excessive. Same (4) In a proceeding to recover an amount referred to in clause (1) (b), the court or body, in addition to any other order it may make, may order the third party to pay the insured person an amount that is less than the amount paid by the insured person to the service provider for the third party service if the court or body finds that the amount charged by the service provider for the third party service is excessive. Determining whether excessive (5) In determining whether an amount charged by a service provider other than a physician for a third party service is excessive, the court or body shall consider any applicable guidelines respecting third party services and any applicable schedule of fees, and may consider any other relevant factors. Same (6) In determining whether an amount charged by a physician for a third party service is excessive, the court or body shall consider the Ontario Medical Association’s guidelines respecting third party services and its schedule of fees, and may consider any other relevant factors. Same (7) The Lieutenant Governor in Council may, in a regulation, provide that the court or body shall consider other matters in addition to or instead of the guidelines and schedules of fees referred to in subsections (5) and (6). Adding service provider as party (8) No order shall be made under subsection (4) unless the service provider has been added as a party to the proceeding. Same (9) The service provider may be added as a party to the proceeding referred to in subsection (4) on such terms as the court or body considers just.  1993, c. 32, s. 2 (7). Section Amendments with date in force (d/m/y) 1993, c. 32, s. 2 (7) - 14/12/1993
36.4 If, under subsection 36.3 (4), the court or body orders the third party to pay the insured person an amount that is less than the amount paid by the insured person to the service provider for the third party service, the service provider is liable to repay the difference to the insured person.  1993, c. 32, s. 2 (7). Section Amendments with date in force (d/m/y) 1993, c. 32, s. 2 (7) - 14/12/1993 General 37 Repealed: 2019, c. 15, Sched. 15, s. 26. Section Amendments with date in force (d/m/y) 1996, c. 1, Sched. H, s. 30 - 01/05/1996 2006, c. 19, Sched. L,s. 3 (6) - 22/06/2006 2007, c. 10, Sched. G, s. 22 (1, 2) - 04/09/2007; 2007, c. 10, Sched. P, s. 16 - 1/07/2015 2009, c. 26, s. 11 (5) - no effect - see 2019, c. 15, Sched. 15, s. 38 - 10/12/2019 2017, c. 25, Sched. 9, s. 97 (8, 9) - no effect - see 2019, c. 15, Sched. 15, s. 39 - 10/12/2019 2019, c. 15, Sched. 15, s. 26 - 10/12/2019 37.1 Repealed: 2019, c. 15, Sched. 15, s. 26. Section Amendments with date in force (d/m/y) 1996, c. 1, Sched. H, s. 31 - 01/05/1996 2002, c. 18, Sched. I, s. 8 (18, 19) - 26/11/2002 2007, c. 10, Sched. G, s. 23 (1-5) - see Table of Public Statute Provisions Repealed Under Section 10.1 of the Legislation Act, 2006 - 31/12/2017; 2007, c. 10, Sched. G, s. 23 (6) - no effect - see 2015, c. 20, Sched. 15, s. 19 - 04/06/2015; 2007, c. 10, Sched. G, s. 23 (7) - 31/03/2010 2009, c. 26, s. 11 (6-10) - no effect - see 2019, c. 15, Sched. 15, s. 38 - 10/12/2019 2015, c. 20, Sched. 15, s. 10 - 29/10/2015 2017, c. 25, Sched. 9, s. 97 (10) - no effect - see 2019, c. 15, Sched. 15, s. 26 - 10/12/2019 2019, c. 15, Sched. 15, s. 26 - 10/12/2019
38 (1) The persons listed in subsection (1.1) shall preserve secrecy with respect to all matters that come to their knowledge in the course of their employment or duties pertaining to insured persons and any insured services rendered and the payments made for those services, and shall not communicate any such matters to any other person except as otherwise provided in this Act, the Personal Health Information Protection Act, 2004 and the Freedom of Information and Protection of Privacy Act.  2007, c. 10, Sched. G, s. 24 (1). Persons referred to in subs. (1) (1.1) The following are listed for the purposes of subsection (1): 1. The members of the Appeal Board. 2. The employees and agents, if any, of the Appeal Board. 3. The General Manager and persons engaged in the administration of this Act.  2007, c. 10, Sched. G, s. 24 (1); 2015, c. 20, Sched. 15, s. 11 (1, 2); 2019, c. 15, Sched. 15, s. 27 (1). (2), (3) Repealed:  2007, c. 10, Sched. G, s. 24 (2). (4) Repealed: 2019, c. 15, Sched. 15, s. 27 (2). Section Amendments with date in force (d/m/y) 1992, c. 32, s. 15 - 3/04/1995; 1998, c. 18, Sched. G, s. 54 (7) - 01/02/1999 2002, c. 18, Sched. I, s. 8 (20) - 26/11/2002 2006, c. 19, Sched. L, s. 11 (3) - 22/06/2006 2007, c. 10, Sched. G, s. 24 (1-4) - 04/09/2007 2015, c. 20, Sched. 15, s. 11 (3) - 29/10/2015 2019, c. 15, Sched. 15, s. 27 (1, 2) - 10/12/2019
38.1 (1) A copy of any of the following may be filed with the Superior Court of Justice after the time in which an appeal may be made has passed, and once filed shall be entered in the same way as a judgment or order of the Superior Court of Justice and is enforceable as an order of that court: 1. A decision of the Appeal Board made under this Act. 2.  Repealed: 2019, c. 15, Sched. 15, s. 28 (1). 3. An agreement to reimburse the Plan signed by a physician. 4.  Repealed: 2019, c. 15, Sched. 15, s. 28 (2). 2007, c. 10, Sched. G, s. 25; 2019, c. 15, Sched. 15, s. 28 (1, 2). Personal property charge (2) Anything that may be filed under subsection (1) may also be entered as a lien and charge with the registrar under the Personal Property Security Act. 2019, c. 15, Sched. 15, s. 28 (3). Set-off (3) For greater certainty, nothing under this section affects any right of set-off that the General Manager possesses under this Act. 2019, c. 15, Sched. 15, s. 28 (3). Section Amendments with date in force (d/m/y) 2004, c. 5, s. 42 - 23/09/2004 2007, c. 10, Sched. G, s. 25 - 04/09/2007 2009, c. 26, s. 11 (11) - no effect - see 2019, c. 15, Sched. 15, s. 38 - 10/12/2019 2019, c. 15, Sched. 15, s. 28 (1-3) - 10/12/2019
39 (1) No action or other proceeding shall be commenced against the Crown, the Minister, the General Manager, any employee or agent of the Crown or a reviewer for anything done or omitted to be done in good faith in the execution or intended execution of a power or duty under this Act. 2019, c. 15, Sched. 15, s. 29. No remedy (2) Despite any other Act or law, no costs, compensation or damages are owing or payable to any person and no remedy, including but not limited to a remedy in contract, restitution, tort or trust, is available to any person against the Crown, the Minister, the General Manager, any employee or agent of the Crown or a reviewer in connection with anything referred to in subsection (1) except as otherwise provided under this Act. 2019, c. 15, Sched. 15, s. 29. Section Amendments with date in force (d/m/y) 1998, c. 18, Sched. G, s. 54 (8) - 01/02/1999 2007, c. 10, Sched. G, s. 26 (1) - 04/09/2007; 2007, c. 10, Sched. G, s. 26 (2) - 01/09/2009 2015, c. 20, Sched. 15, s. 12 - 29/10/2015 2019, c. 15, Sched. 15, s. 29 - 10/12/2019
39.1 (1) No cause of action arises as a direct or indirect result of, (a) the enactment or repeal of any provision of this Act; or (b) the making or revocation of any provision of the regulations made under this Act. 2019, c. 15, Sched. 15, s. 29. No remedy (2) No costs, compensation or damages are owing or payable to any person and no remedy, including but not limited to a remedy in contract, restitution, tort or trust, is available to any person in connection with anything referred to in clause (1) (a) or (b). 2019, c. 15, Sched. 15, s. 29. Proceedings barred (3) No proceeding, including but not limited to any proceeding in contract, restitution, tort or trust, that is directly or indirectly based on or related to anything referred to in subsection (1) may be brought or maintained against any person. 2019, c. 15, Sched. 15, s. 29. Same (4) Subsection (3) applies regardless of whether the cause of action on which the proceeding is purportedly based arose before or after that subsection came into force. 2019, c. 15, Sched. 15, s. 29. Person defined (5) In this section, “person” includes the Crown and its employees and agents and members of the Executive Council. 2019, c. 15, Sched. 15, s. 29. Section Amendments with date in force (d/m/y) 1996, c. 1, Sched. H, s. 33 - 01/05/1996 2002, c. 18, Sched. I, s. 8 (21) - 26/11/2002 2007, c. 10, Sched. G, s. 27 (1-4) - 04/09/2007 2015, c. 20, Sched. 15, s. 13 - 29/10/2015 2019, c. 15, Sched. 15, s. 29 - 10/12/2019
39.2 (1) No cause of action arises against the Crown, a minister of the Crown, a Crown employee, a Crown agent or the General Manager as a result of any act or omission of a person who is not a minister of the Crown, a Crown employee, a Crown agent or the General Manager if the act or omission is related, directly or indirectly, to the activities or affairs of a reviewer or to the administration of this Act. 2019, c. 15, Sched. 15, s. 29. No proceeding (2) No proceeding for damages, including but not limited to a proceeding for a remedy in contract, restitution, tort or trust, shall be instituted against the Crown, a minister of the Crown, a Crown employee, a Crown agent or the General Manager by a person who has suffered any damages, injury or other loss based on or related to any act or omission described in subsection (1). 2019, c. 15, Sched. 15, s. 29. Section Amendments with date in force (d/m/y) 2019, c. 15, Sched. 15, s. 29 - 10/12/2019
39.3 The amendments to this Act made by Schedule 15 to the Plan to Build Ontario Together Act, 2019, and any regulations made in consequence of those amendments, apply despite any agreement or arrangement entered into by the Minister, regardless of when the agreement or arrangement might have been made. 2019, c. 15, Sched. 15, s. 29. Section Amendments with date in force (d/m/y) 2019, c. 15, Sched. 15, s. 29 - 10/12/2019
39.4 (1) Subject to the regulations, if any, the General Manager is authorized to publish information, including personal information other than personal health information, that relates to any payments under this Act to a physician, practitioner or health facility, including payments that are made to a person or entity pursuant to an arrangement under clause 2 (2) (a) or a direction under section 16.1. 2019, c. 15, Sched. 15, s. 29. Exception (2) This section does not authorize the publication by the General Manager or the Minister of information concerning an opinion that the General Manager has formed under subsection 18 (8) or section 18.2, or a hearing that the General Manager has requested in connection with such an opinion. 2019, c. 15, Sched. 15, s. 29. Section Amendments with date in force (d/m/y) 2019, c. 15, Sched. 15, s. 29 - 10/12/2019 40 Repealed: 2015, c. 20, Sched. 15, s. 13. Section Amendments with date in force (d/m/y) 1996, c. 1, Sched. H, s. 34 - 01/05/1996 2007, c. 10, Sched. G, s. 28 - 04/09/2007 2015, c. 20, Sched. 15, s. 13 - 29/10/2015 40.1 Repealed: 2015, c. 20, Sched. 15, s. 13. Section Amendments with date in force (d/m/y) 1996, c. 1, Sched. H, s. 34 - 01/05/1996 2007, c. 10, Sched. G, s. 29 (1-3) - 04/09/2007 2009, c. 33, Sched. 6, s. 61 - 1/06/2011 2015, c. 20, Sched. 15, s. 13 - 29/10/2015 40.2 Repealed: 2015, c. 20, Sched. 15, s. 13. Section Amendments with date in force (d/m/y) 1996, c. 1, Sched. H, s. 34 - 01/05/1996 2007, c. 10, Sched. G, s. 30 (1, 2) - 04/09/2007 2015, c. 20, Sched. 15, s. 13 - 29/10/2015
40.3 The General Manager may suspend payments or a portion of payments to a physician, practitioner or heath facility from the Plan, (a) during any period when they fail to comply with section 17.3, whether or not they are convicted of an offence; (b) during any period where they fail to co-operate with a reviewer; or (c) during any other period as may be prescribed, or for any other reason as may be prescribed. 2019, c. 15, Sched. 15, s. 30. Section Amendments with date in force (d/m/y) 2007, c. 10, Sched. G, s. 31 - 31/03/2010 2019, c. 15, Sched. 15, s. 30 - 10/12/2019
42 (1) In any proceeding, other than a prosecution, a copy of an inspection report that appears to be signed by a reviewer or the General Manager, or a copy of a decision of the General Manager made under this Act or the regulations, is admissible as evidence of the inspection report or decision and of the facts appearing in the document without further proof. 2019, c. 15, Sched. 15, s. 31 (1). Same (2) In any proceeding, other than a prosecution, a copy of a record or thing made under clause 41 (7) (c) that appears to be certified as a true copy of the original by a reviewer is admissible as evidence of the record or thing and of the facts appearing in it without further proof. 2019, c. 15, Sched. 15, s. 31 (1). Same, prosecution (3) In any prosecution, a copy of a decision, direction or inspection report made under this Act or the regulations that appears to be signed by a reviewer or the General Manager is admissible as evidence, in the absence of evidence to the contrary, of the decision, direction or inspection report and of the facts appearing in the document without further proof. 2019, c. 15, Sched. 15, s. 31 (1). Same (4) In any prosecution, a copy of a record or thing made under clause 41 (7) (c) that appears to be certified as a true copy of the original by a reviewer is admissible as evidence, in the absence of evidence to the contrary, of the record or thing and of the facts appearing in it without further proof. 2019, c. 15, Sched. 15, s. 31 (1). Transition (5) This section applies, with necessary modification, to any notice of the General Manager issued under subsection 18 (14) or (15) of this Act as they existed before subsection 32 (1) of Schedule 15 to the Plan to Build Ontario Together Act, 2019
came into force. 2019, c. 15, Sched. 15, s. 31 (1). Section Amendments with date in force (d/m/y) 2000, c. 26, Sched. H, s. 1 (7) - 06/12/2000 2019, c. 15, Sched. 15, s. 31 (1) - 10/12/2019
42.1 (1) On application without notice, a justice may issue an order authorizing a reviewer named in the order to enter a place specified in the order and to exercise any of the powers mentioned in subsection 41 (7), if the justice is satisfied on information under oath that the reviewer has been prevented from entering a place that may be entered under section 41, or has been prevented from exercising a power mentioned in subsection 41 (7), or that there are reasonable grounds to believe that the reviewer will be prevented from entering the place or exercising the power. 2019, c. 15, Sched. 15, s. 31 (1). Expiry (2) An order shall name a date on which it expires, which shall not be later than 30 days after the order is issued. 2019, c. 15, Sched. 15, s. 31 (1). Extension of time (3) A justice may extend the date on which an order expires for an additional period of no more than 30 days, upon application without notice by the reviewer named in the order. 2019, c. 15, Sched. 15, s. 31 (1). Police assistance (4) A reviewer named in an order may call upon a police officer for assistance in executing the order and the police officer may use whatever force the police officer considers necessary to execute the order. 2019, c. 15, Sched. 15, s. 31 (1). Time of execution (5) An order may be executed only between 6 a.m. and 9 p.m. unless the order specifies otherwise. 2019, c. 15, Sched. 15, s. 31 (1). Other matters (6) Subsections 41 (3) to (4) and (6) to (14) apply, with necessary modifications, to the execution of an order. 2019, c. 15, Sched. 15, s. 31 (1). Section Amendments with date in force (d/m/y) 2019, c. 15, Sched. 15, s. 31 (1) - 10/12/2019
42.2 Where a reviewer is conducting an inspection under section 41 or executing an order under section 42.1 or where a provincial offences officer is executing a warrant under section 158 or 158.1 of the Provincial Offences Act
with respect to a matter relevant to this Act, no person shall, (a) hinder, obstruct or interfere with the reviewer or officer, or otherwise impede the reviewer or officer; (b) destroy or alter a record or other thing that has been demanded under clause 41 (8) (b) or that is the subject of a warrant under section 158 or 158.1 of the Provincial Offences Act; or (c) fail to do anything required under subsections 41 (9) or (11) or subsection 42.3 (7). 2019, c. 15, Sched. 15, s. 31 (1). Section Amendments with date in force (d/m/y) 2019, c. 15, Sched. 15, s. 31 (1) - 10/12/2019
42.3 (1) On application without notice by a provincial offences officer, a justice may issue a production order to a person, other than a person under investigation for an offence, requiring the person to, (a) produce documents or copies of documents, certified by affidavit to be true copies, or produce data; or (b) prepare a document based on documents or data already in existence and produce it. 2019, c. 15, Sched. 15, s. 31 (1). Contents of order (2) A production order must stipulate when, where and how the documents or data are to be produced, and to whom they are to be produced. 2019, c. 15, Sched. 15, s. 31 (1). Grounds (3) A justice may make a production order if satisfied by information given under oath or affirmation that there are reasonable grounds to believe that, (a) an offence under this Act has been or is being committed; (b) the document or data will provide evidence respecting the offence or suspected offence; and (c) the person who is subject to the order has possession or control of the document or data. 2019, c. 15, Sched. 15, s. 31 (1). Conditions (4) A production order may contain any conditions the justice considers advisable. 2019, c. 15, Sched. 15, s. 31 (1). Evidence (5) A copy of a document or data produced under this section, on proof by affidavit that it is a true copy, is admissible in evidence in proceedings under this Act and has the same probative force as the original document or data would have if it had been proved in the ordinary way. 2019, c. 15, Sched. 15, s. 31 (1). No return of copies (6) Copies of documents or data produced under this section are not required to be returned to the person who provided them. 2019, c. 15, Sched. 15, s. 31 (1). Compliance required (7) A person to whom a production order is directed shall comply with the order according to its terms. 2019, c. 15, Sched. 15, s. 31 (1). Section Amendments with date in force (d/m/y) 2019, c. 15, Sched. 15, s. 31 (1) - 10/12/2019
42.4 A reviewer or person who, at the request of a reviewer, accompanies a reviewer in doing anything authorized under this Act is not a compellable witness in a civil suit or any proceeding respecting any information or material furnished, obtained, made or received by them under this Act while acting within the scope of their employment. 2019, c. 15, Sched. 15, s. 31 (1). Section Amendments with date in force (d/m/y) 2019, c. 15, Sched. 15, s. 31 (1) - 10/12/2019
42.5 In a prosecution for an offence under this Act or where documents or materials provided for under section 42.3 of this Act or sections 158 to 160 of the Provincial Offences Act are filed with a court in relation to an inspection or an investigation into an offence under this Act, the court may, at any time, take precautions to avoid the disclosure by the court or any person of any personal information about an individual, including, where appropriate, (a) removing the identifying information of any person whose personal information is referred to in any documents or materials; (b) receiving representations without notice; (c) conducting hearings or parts of hearings in private; or (d) sealing all or part of the court files. 2019, c. 15, Sched. 15, s. 31 (1). Section Amendments with date in force (d/m/y) 2019, c. 15, Sched. 15, s. 31 (1) - 10/12/2019
42.6 (1) In any proceeding under this Act, the Commitment to the Future of Medicare Act, 2004 or the Integrated Community Health Services Centres Act, 2023, a document purporting to be an extract of data or information from any database maintained and used by the Ministry in the ordinary course of business to record and track information about claims made under this Act or the Independent Health Facilities Act and payments made under this Act or that Act that appears to be certified as a true extract by the General Manager is admissible as evidence of the information contained in the extract and of the facts appearing in it without further proof. 2019, c. 15, Sched. 15, s. 31 (1); 2023, c. 4, Sched. 1, s. 71 (7). Prosecutions (2) Subsection (1) does not apply in respect of a prosecution. 2019, c. 15, Sched. 15, s. 31 (1). Section Amendments with date in force (d/m/y) 2019, c. 15, Sched. 15, s. 31 (1) - 10/12/2019; 2019, c. 15, Sched. 15, s. 31 (3) - no effect - see 2023, c. 4, Sched. 1, s. 76 (3) 2023, c. 4, Sched. 1, s. 71 (7) - 25/09/2023
43 (1) No person shall obtain or attempt to obtain payment for any insured service that the person knows or ought to have known they are not entitled to obtain under this Act or the regulations. 2019, c. 15, Sched. 15, s. 32. Offence, benefits without entitlement (2) No person shall receive or attempt to receive the benefit of any insured service that the person knows or ought to have known they are not entitled to receive under this Act or the regulations. 2019, c. 15, Sched. 15, s. 32. False information (3) No person shall give information that they knew or ought to have known was false in an application, return, statement, account or claim for payment provided to the Plan or to the General Manager in respect of any matter under this Act or the regulations, including in any information provided under section 17.3. 2019, c. 15, Sched. 15, s. 32. Section Amendments with date in force (d/m/y) 2019, c. 15, Sched. 15, s. 32 - 10/12/2019
43.1 (1) A prescribed person who, in the course of his or her professional or official duties, has knowledge that an event referred to in subsection (2) has occurred shall promptly report the matter to the General Manager. Events (2) Subsection (1) applies to the following events: 1. An ineligible person receives or attempts to receive an insured service as if he or she were an insured person. 2. An ineligible person obtains or attempts to obtain reimbursement by the Plan for money paid for an insured service as if he or she were an insured person. 3. An ineligible person, in an application, return or statement made to the Plan or the General Manager, gives false information about his or her residency. Definition, “ineligible person” (3) In subsection (2), “ineligible person” means a person who is neither an insured person nor entitled to become one. Defence (4) It is a defence to a proceeding for failure to make a report required by subsection (1) that the prescribed person delayed making the report because he or she believed, on reasonable grounds, that making the report might be a direct and immediate cause of serious bodily harm to a person, and made the report as soon as he or she was of the opinion that the danger no longer existed. Voluntary reporting (5) A prescribed person may report to the General Manager any matter relating to the administration or enforcement of this Act or the regulations. Subss. (1) and (5) prevail (6) Subsections (1) and (5) apply even if the information reported is confidential or privileged and despite any Act, regulation or other law prohibiting disclosure of the information. Protection from liability (7) No proceeding for making a report under subsection (1) or (5) or for providing information in connection with the report shall be commenced against a person unless he or she acts maliciously and the information on which the report is based is not true. Exception: solicitor-client privilege (8) Nothing in this section abrogates any privilege that may exist between a solicitor and his or her client.  1993, c. 32, s. 2 (8). Section Amendments with date in force (d/m/y) 1993, c. 32, s. 2 (8) - 14/12/1993
44 (1) Every individual who contravenes any provision of this Act or the regulations for which no penalty is specifically provided is guilty of an offence and is liable, (a) for a first offence, to a fine of not more than $50,000 or to imprisonment for a term of not more than 12 months, or to both; and (b) for a subsequent offence, to a fine of not more than $100,000 or to imprisonment for a term of not more than 12 months, or to both. 2019, c. 15, Sched. 15, s. 33. No imprisonment for record-keeping offences (2) Despite subsection (1), no person may be sentenced to a term of imprisonment for failing to keep or maintain records under section 17.4. 2019, c. 15, Sched. 15, s. 33. Same, corporation (3) Every corporation that contravenes any provision of this Act or the regulations for which no penalty is specifically provided is guilty of an offence and is liable to a fine of not more than $100,000 for a first offence and to a fine of not more than $500,000 for a subsequent offence. 2019, c. 15, Sched. 15, s. 33. Compensation or restitution (4) The court that convicts a person of an offence under this section may, in addition to any other penalty, order that the person pay compensation or make restitution to any person who suffered a loss as a result of the offence. 2019, c. 15, Sched. 15, s. 33. No limitation (5) Section 76 of the Provincial Offences Act does not apply to a prosecution under this Act. 2019, c. 15, Sched. 15, s. 33. Presiding judge (6) The Crown may, by notice to the clerk of the Ontario Court of Justice, require that a provincial judge preside over a proceeding in respect of an offence under subsection (1). 2019, c. 15, Sched. 15, s. 33. Section Amendments with date in force (d/m/y) 2002, c. 18, Sched. I, s. 8 (22) - 26/11/2002 2007, c. 10, Sched. G, s. 32 - 04/09/2007 2019, c. 15, Sched. 15, s. 33 - 10/12/2019
45.1 (1) Every decision by a body designated or established under clause 45 (1.1) (f) respecting a dispute about payment for third party services shall be final and binding and shall not be subject to appeal.  1993, c. 32, s. 2 (11). Enforcement of decision (2) The body designated or established under clause 45 (1.1) (f) or a party to a proceeding before the body may file a copy of the decision or order of the body, excluding the reasons, in the Superior Court of Justice or, if the amount ordered to be paid does not exceed the monetary jurisdiction of the Small Claims Court, in the Small Claims Court and, when so filed, the decision or order may be enforced as an order of the court in which it is filed.  1993, c. 32, s. 2 (11); 2006, c. 19, Sched. C, s. 1 (1). Section Amendments with date in force (d/m/y) 1993, c. 32, s. 2 (11) - 14/12/1993 2006, c. 19, Sched. C, s. 1 (1) - 22/06/2006 Mental Illness Mental illness
46 (1) In this section, “hospital” means a psychiatric facility under the Mental Health Act.  R.S.O. 1990, c. H.6, s. 46 (1); 2009, c. 33, Sched. 18, s. 11 (10). Insured person entitled (2) An insured person who is entitled to insured services under this Act and the regulations and who is admitted to a hospital under this section is entitled to such services as are required for the person’s maintenance, care, diagnosis and treatment in accordance with this Act and the regulations without being required to pay or have paid on his or her behalf any premium or other charge other than a co-payment for accommodation prescribed in the regulations. 1994, c. 17, s. 73. Exceptions (3) Despite subsection (2), an insured person in respect of whom, but for this Act, the Government of Canada would have assumed the cost of the maintenance, care, diagnosis and treatment provided under this section is not entitled to receive insured services in a hospital as an insured person. Accounts (4) The General Manager shall keep the accounts, if any, of insured persons who receive hospital services under this section separate from the accounts of patients who receive insured services under the Plan. Subrogation (5) Where, as the result of negligence or other wrongful act or omission of another, an insured person suffers personal injuries for which he or she receives services under this section, the Plan is subrogated to any right of the insured person to recover the cost incurred for such services, past or future, and the provisions of this Act and the regulations applying to subrogation of the Plan for the cost of insured services apply with necessary modifications to subrogation of the Plan for the cost of services under this section.  R.S.O. 1990, c. H.6, s. 46 (3-5). Section Amendments with date in force (d/m/y) 1994, c. 17, s. 73 - 18/05/1994 2009, c. 33, Sched. 18, s. 11 (10) - 15/12/2009 SCHEDULE 1   PHYSICIAN PAYMENT REVIEW PROCESS