38.2 (1) This section applies to an application prepared by a member of a health profession or social worker for approval of an assessment or examination of an insured person if the application is not submitted as part of a treatment plan under section 38.  O. Reg. 546/05, s. 16 (1). (2) The application shall include a statement by the member of a health profession or social worker who is to conduct the assessment or examination, (a)  disclosing any conflict of interest that he or she has relating to the assessment or examination to which the application relates; (b)  indicating that he or she has made reasonable inquiries to determine whether any person who referred the insured person to him or her has a conflict of interest relating to the assessment or examination and, if there is a conflict of interest, disclosing the conflict of interest that the person has; and (c)  stating that the assessment or examination is reasonably required in relation to a benefit.  O. Reg. 281/03, s. 17; O. Reg. 546/05, s. 16 (2); O. Reg. 533/06, s. 9. (3) A lawyer or other representative who acts for the insured person in respect of the application or with respect to any civil proceeding arising from the accident shall, at the time the application is submitted, give the insurer and the insured person written notice disclosing any conflict of interest that the lawyer or other representative has relating to the application.  O. Reg. 281/03, s. 17. (4) If a conflict of interest is disclosed under subsection (2) or (3), the insurer may refuse the application and, within two business days after receiving the application, give the insured person notice that the application is refused and that the insured person may submit a new application.  O. Reg. 281/03, s. 17. (5) Despite subsection (4), the insurer shall not refuse the application because of a conflict of interest if there is no other person within 50 kilometres of the insured person’s residence who is able to conduct the assessment or examination.  O. Reg. 281/03, s. 17. (6) If the insurer has not refused the application under subsection (4), the insurer shall give the insured person and the person who prepared the application a notice, (a)  within two business days after receiving the application if the application is received before March 1, 2006 and the amount to be charged is $180 or less; (b)  within five business days after receiving the application if the application is received before March 1, 2006 and the amount to be charged exceeds $180; or (c)  within three business days after receiving the application, if the application is received on or after March 1, 2006.  O. Reg. 546/05, s. 16 (3). (7) The notice under subsection (6) must, (a)  state which assessments or examinations in the application the insurer agrees to pay for; (b)  advise the insured person that the insurer requires the insured person to be examined under section 42, if the insurer has not agreed to pay for all assessments or examinations to which the application relates; and (c)  disclose any conflict of interest that the insurer has relating to any assessment or examination to which the application relates.  O. Reg. 546/05, s. 16 (3). (8) A notice required under subsection (6) may be given verbally if, as soon as practicable afterwards, written confirmation of the notice is given to every person who received verbal notice.  O. Reg. 546/05, s. 16 (3). (9) If the insurer does not refuse the application under subsection (4) but fails to give the notice as required under subsection (6), the insurer shall pay for all assessments and examinations to which the application relates.  O. Reg. 281/03, s. 17. (10) If, in a notice under subsection (6), the insurer discloses a conflict of interest relating to an assessment or examination, the insured person may withdraw the application and submit a new application within two business days after receiving the notice from the insurer.  O. Reg. 281/03, s. 17. (11) Despite subsection (10), the insured person shall not withdraw the application or submit a new application if there is no other person within 50 kilometres of the insured person’s residence who is able to conduct the assessment or examination.  O. Reg. 281/03, s. 17. (12) If the application is not withdrawn under subsection (10), the insurer shall pay for all assessments and examinations it agreed to pay for in the notice under subsection (6) and shall make each payment within 30 days after receiving an invoice for the cost of the assessment or examination.  O. Reg. 281/03, s. 17. (13) Within five business days after receiving the report of an examination under section 42, the insurer shall give a copy of the report and the insurer’s determination with respect to the application to the insured person and the person who prepared the application.  O. Reg. 546/05, s. 16 (4). (13.1) The determination of the insurer shall specify the assessments or examinations the insurer agrees to pay for, the assessments or examinations the insurer refuses to pay for and the reasons for the insurer’s decision.  O. Reg. 546/05, s. 16 (4). (13.2) If an insured person fails or refuses to comply with subsection 42 (10), the insurer may make a determination that the insured person is not entitled to the expenses to which the examination relates.  O. Reg. 546/05, s. 16 (4). (13.3) If an insured person subsequently complies with subsection 42 (10), the insurer shall reconsider the application and make a determination under this section.  O. Reg. 546/05, s. 16 (4). (13.4) If the insurer fails to provide a copy of the report of the examination under section 42 or its determination in respect of the application by the day determined in the following manner, the insurer shall pay for all assessments and examinations to which the application relates: 1.  If the attendance of the insured person was not required for the examination under section 42, the day is the 10th business day after the day the material required under subsection 42 (10) was provided. 2.  If the attendance of the insured person was required for the examination, the day is the 15th business day after the day the examination was completed or was required under paragraph 2 or 3 of subsection 42 (11) to be completed.  O. Reg. 546/05, s. 16 (4). (13.5) An insurer shall pay for all assessments and examinations that it has agreed to pay for or that it is required under this section to pay for within 30 days after receiving an invoice for the cost of the assessment or examination.  O. Reg. 546/05, s. 16 (4). (14) If, after giving a notice under subsection (6) in which the insurer agrees to pay for an assessment or examination, it comes to the insurer’s attention that a person described in subsection (2) or (3) has a conflict of interest relating to the assessment or examination, the insurer may give the insured person notice requiring the insured person, within five business days after receiving the notice, to amend the application so that no conflict of interest will arise.  O. Reg. 281/03, s. 17. (15) If the insured person does not amend the application as required under subsection (14), the insurer is not required to pay for the assessment or examination referred to in that subsection.  O. Reg. 281/03, s. 17. (16) Subsection (14) does not apply if there is no other person within 50 kilometres of the insured person’s residence who is able to conduct the assessment or examination to which the conflict of interest relates.  O. Reg. 281/03, s. 17. Conflict of Interest