42.
 42. (1) Subject to subsection (2), an application for attendant care benefits for an insured person must be, (a)  in the form of and contain the information required to be provided in the version of the document entitled “Assessment of Attendant Care Needs” that is approved by the Chief Executive Officer for use in connection with the claim; and (b)  prepared and submitted to the insurer by an occupational therapist or a registered nurse.  O. Reg. 34/10, s. 42 (1); O. Reg. 123/19, s. 9. (2) If a Guideline issued for the purpose of this section specifies conditions, restrictions or limits with respect to the preparation of an assessment of attendant care needs, the assessment of attendant care needs must be prepared in accordance with the Guideline.  O. Reg. 34/10, s. 42 (2). (3) Within 10 business days after receiving the assessment of attendant care needs, the insurer shall give the insured person a notice that specifies the expenses described in the assessment of attendant care needs the insurer agrees to pay, the expenses the insurer refuses to pay and the medical and any other reasons for the insurer’s decision.  O. Reg. 34/10, s. 42 (3). (4) A notice under subsection (3) may require the insured person to undergo an examination under section 44 if the insurer has not agreed to pay all expenses described in the assessment of attendant care needs.  O. Reg. 34/10, s. 42 (4). (5) An insurer may, but is not required to, pay an expense incurred before an assessment of attendant needs that complies with this section is submitted to the insurer.  O. Reg. 34/10, s. 42 (5). (6) The insurer shall begin payment of attendant care benefits within 10 business days after receiving the assessment of attendant care needs and, pending receipt by the insurer of the report of any examination under section 44 required by the insurer, shall calculate the amount of the benefits based on the assessment of attendant care needs.  O. Reg. 34/10, s. 42 (6). (7) If an insurer wants to determine if an insured person is still entitled to attendant care benefits, wants to determine if the benefits are being paid in the appropriate amount or wants to determine both, the insurer shall give the person a notice requesting that a new assessment of attendant care needs for the insured person be prepared in accordance with this section and submitted to the insurer within 15 business days after the insured person receives the notice.  O. Reg. 34/10, s. 42 (7). (8) Subject to subsection (12), a notice under subsection (7) may also advise the insured person that the insurer requires an examination under section 44.  O. Reg. 34/10, s. 42 (8). (9) Subject to subsection (12), new assessments of attendant care needs may be submitted to an insurer at any time there are changes that would affect the amount of the benefits.  O. Reg. 34/10, s. 42 (9). (10) If a new assessment of attendant care needs indicates that it is appropriate to increase the amount of the attendant care benefits and the insurer has not already advised the insured person that the insurer requires an examination under section 44, the insurer may give a notice to the insured person advising that the insurer requires an examination under that section.  O. Reg. 34/10, s. 42 (10). (11) If a new assessment of attendant care needs is required under subsection (7) or the insurer requires an examination under section 44, the insurer shall, subject to subsection 18 (3) and section 20, continue to pay the insured person attendant care benefits at the same rate until the insurer receives the assessment of attendant care needs or the report of the examination, as applicable.  O. Reg. 34/10, s. 42 (11); O. Reg. 251/15, s. 16 (1). (12) If more than 104 weeks have elapsed since the accident, the insurer shall not require an examination under section 44 to determine the insured person’s entitlement to attendant care benefits and the insured person shall not submit nor be required to submit an assessment of attendant care needs to the insurer unless at least 52 weeks have elapsed since the last examination under section 44 relating to entitlement to attendant care benefits. O. Reg. 251/15, s. 16 (2). (13) Within 10 business days after receiving the report of an examination under section 44, the insurer shall, (a)  give a copy of the report to the person who prepared the assessment of attendant care needs; and (b)  provide the insured person with a notice specifying the benefits and expenses the insurer agrees to pay, the benefits and expenses the insurer refuses to pay and the medical and any other reasons for the insurer’s decision.  O. Reg. 34/10, s. 42 (13). (14) If an insured person fails or refuses to comply with subsection 44 (9), the insurer may, (a)  make a determination that the insured person is not entitled to attendant care benefits; and (b)  refuse to pay attendant care benefits relating to the period after the person failed or refused to comply with that subsection and before the insured person submits to the examination and provides the material required by that subsection.  O. Reg. 34/10, s. 42 (14). (15) If an insured person subsequently complies with subsection 44 (9), the insurer shall, (a)  reconsider the application and make a determination under this section; (b)  subject to the new determination, subsection 18 (3) and section 20, resume payment of attendant care benefits; and (c)  pay all amounts, if any, that were withheld during the period of non-compliance, if the insured person provides, not later than the 10th business day after the failure or refusal to comply, or as soon as practicable after that day, a reasonable explanation for not complying with that subsection.  O. Reg. 34/10, s. 42 (15); O. Reg. 251/15, s. 16 (3). (16) If an insurer determines that an insured person is not entitled by reason of section 20 to attendant care benefits for expenses incurred more than 260 weeks after the accident, the insurer shall give the insured person a notice of its determination, with reasons, not less than 10 business days before the last payment of attendant care benefits.  O. Reg. 34/10, s. 42 (16); O. Reg. 251/15, s. 16 (4). Other Types of Benefits