38.
 38. (1) This section applies to, (a)  medical and rehabilitation benefits other than benefits payable in accordance with the Minor Injury Guideline; and (b)  all applications for approval of assessments or examinations.  O. Reg. 34/10, s. 38 (1). (2) An insurer is not liable to pay an expense in respect of a medical or rehabilitation benefit or an assessment or examination that was incurred before the insured person submits a treatment and assessment plan that satisfies the requirements of subsection (3) unless, (a)  the insurer gives the insured person a notice under subsection 39 (1) stating that the insurer will pay the expense without a treatment and assessment plan; (b)  the expense is for an ambulance or other goods or services provided on an emergency basis not more than five business days after the accident to which the application relates; (c)  the expense is reasonable and necessary as a result of the impairment sustained by the insured person for, (i)  drugs prescribed by a regulated health professional, or (ii)  goods referred to in clauses 15 (1) (d) to (f) and 16 (3) (h) to (j) with a cost of $250 or less per item; or (d)  the insurer agrees that the expense is essential for the treatment or rehabilitation of the insured person for goods or services referred to in clause 15 (1) (h) or 16 (3) (l) with a cost of $250 or less per item or service, as the case may be. O. Reg. 34/10, s. 38 (2); O. Reg. 251/15, s. 13 (1, 2). (3) A treatment and assessment plan must, (a)  be signed by the insured person unless the insurer waives that requirement; (b)  be completed and signed by a regulated health professional; and (c)  include a statement by a health practitioner approving the treatment and assessment plan and stating that he or she is of the opinion that the goods, services, assessments and examinations described in the treatment and assessment plan and their proposed costs are reasonable and necessary for the insured person’s treatment or rehabilitation and, (i)  stating, if the treatment and assessment plan is in respect of an accident that occurred on or after September 1, 2010, (A)  that the insured person’s impairment is not predominantly a minor injury, or (B)  that the insured person’s impairment is predominantly a minor injury but, based on compelling evidence provided by the health practitioner, the insured person does not come within the Minor Injury Guideline because the insured person has a pre-existing medical condition that was documented by a health practitioner before the accident and that will prevent the insured person from achieving maximal recovery from the minor injury if the insured person is subject to the limit or is limited to the goods and services authorized under the Minor Injury Guideline, or (ii)  stating, if the treatment and assessment plan is in respect of an accident that occurred before September 1, 2010, that the expenses contemplated by the treatment and assessment plan are reasonable and necessary for the insured person’s treatment or rehabilitation. O. Reg. 34/10, s. 38 (3); O. Reg. 347/13, s. 4; O. Reg. 251/15, s. 13 (3); O. Reg. 123/19, s. 7. (4) A claim for dental goods or services completed and signed by a dentist and in the form approved by the Ontario Dental Association is deemed to be a treatment and assessment plan that satisfies the requirements of subsection (3).  O. Reg. 34/10, s. 38 (4). (5) An insurer may refuse to accept a treatment and assessment plan if the plan describes goods or services to be received or an assessment or examination to be conducted in respect of any period during which the insured person is entitled to receive goods or services under the Minor Injury Guideline in respect of the impairment.  O. Reg. 34/10, s. 38 (5). (6) An insurer’s refusal to accept a treatment and assessment plan under subsection (5) is final and is not subject to review.  O. Reg. 34/10, s. 38 (6). (7) Nothing in subsection (5) prevents an insured person, while receiving goods or services under the Minor Injury Guideline, from submitting a treatment and assessment plan applicable to a period other than the period for which the insured person is receiving goods or services under the Minor Injury Guideline.  O. Reg. 34/10, s. 38 (7). (8) Within 10 business days after it receives the treatment and assessment plan, the insurer shall give the insured person a notice that identifies the goods, services, assessments and examinations described in the treatment and assessment plan that the insurer agrees to pay for, any the insurer does not agree to pay for and the medical reasons and all of the other reasons why the insurer considers any goods, services, assessments and examinations, or the proposed costs of them, not to be reasonable and necessary.  O. Reg. 34/10, s. 38 (8); O. Reg. 14/13, s. 5. (8.1) If the insurer has not agreed that the goods and services referred to in clause 15 (1) (h) or 16 (3) (l) are essential, the notice under subsection (8) must so advise the insured person. O. Reg. 251/15, s. 13 (4). (9) If the insurer believes that the Minor Injury Guideline applies to the insured person’s impairment, the notice under subsection (8) must so advise the insured person.  O. Reg. 34/10, s. 38 (9). (10) If the insurer has not agreed to pay for all goods, services, assessments and examinations described in the treatment and assessment plan or believes that the Minor Injury Guideline applies to the insured person’s impairment, the notice under subsection (8) may notify the insured person that the insurer requires the insured person to undergo an examination under section 44.  O. Reg. 34/10, s. 38 (10). (11) If the insurer fails to give a notice in accordance with subsection (8) in connection with a treatment and assessment plan, the following rules apply: 1.  The insurer is prohibited from taking the position that the insured person has an impairment to which the Minor Injury Guideline applies. 2.  The insurer shall pay for all goods, services, assessments and examinations described in the treatment and assessment plan that relate to the period starting on the 11th business day after the day the insurer received the application and ending on the day the insurer gives a notice described in subsection (8).  O. Reg. 34/10, s. 38 (11). (12) If an insurer advises an insured person that the Minor Injury Guideline applies, the insured person may submit a treatment confirmation form under section 40 and, pending the insurer’s determination, may receive goods and services in accordance with the Minor Injury Guideline.  O. Reg. 34/10, s. 38 (12). (13) Within 10 business days after receiving the report of an examination conducted under section 44 for the purpose of the treatment and assessment plan, the insurer shall give a copy of the report to the insured person and to the regulated health professional who prepared the treatment and assessment plan.  O. Reg. 34/10, s. 38 (13). (14) Within 10 business days after receiving the report, the insurer shall, (a)  provide the insured person with a notice indicating the goods and services described in the treatment and assessment plan that the insurer agrees to pay for, the goods and services the insurer refuses to pay for and the medical and any other reasons for the insurer’s decision; or (b)  if the insurer determines that the Minor Injury Guideline applies, advise the insured person that the Minor Injury Guideline applies to the insured person’s impairment and provide medical and any other reasons for the insurer’s determination.  O. Reg. 34/10, s. 38 (14). (15) The insurer shall pay for goods and services the insurer agreed to pay for in the notice under subsection (8) or (14) or is required to pay for under this section within 30 days after receiving an invoice for them.  O. Reg. 34/10, s. 38 (15).