jswizzle3737/ontario_laws_and_regs huggingface dataset:
47. (1) A person shall repay to the insurer, (a)  any benefit under this Regulation that is paid to the person as a result of an error on the part of the insurer, the insured person or any other person, or as a result of wilful misrepresentation or fraud; (b)  any income replacement or non-earner benefit that is paid to the person if he or she, or a person in respect of whom the payment was made, was disqualified from payment under Part IX; (c)  any income replacement, non-earner or caregiver benefit or any benefit under Part VI, to the extent of any payments received by the person that are deductible from those benefits under this Regulation; (d)  if, by reason of subsection 41.1 (1), subsection 37 (4), as it read on February 28, 2006, applies, any income replacement benefits, non-earner or caregiver benefits that is paid for the period after the insurer gave notice under subsection 37 (1), as it read on that date, and before the date of the report of the designated assessment centre; or (e)  fees paid by the insurer that are referred to in paragraph 8 of subsection 24 (1) if the insured person fails, without a reasonable explanation, to attend a designated assessment that has been arranged, or cancels a designated assessment without providing such notice as may be specified in the Pre-assessment Cancellation Fee Schedule established by the committee referred to in section 52, as it may be amended from time to time, that he or she will not be attending the designated assessment.  O. Reg. 403/96, s. 47 (1); O. Reg. 281/03, s. 22; O. Reg. 546/05, s. 23. (2) If a person is required to repay an amount to an insurer under this section, (a)  the insurer shall give the person notice of the amount that is required to be repaid; and (b)  if the person is receiving an income replacement or caregiver benefit, the insurer may give the person notice that the insurer intends to collect the repayment by deducting up to 20 per cent of the amount of the benefit from each payment of the benefit.  O. Reg. 403/96, s. 47 (2). (3) The obligation to repay a benefit does not apply unless the notice under subsection (2) is given within 12 months after the payment was made.  O. Reg. 403/96, s. 47 (3). (4) Subsection (3) does not apply if the benefit was paid as a result of wilful misrepresentation or fraud.  O. Reg. 403/96, s. 47 (4). (5) An insurer that has given the notice referred to in clause (2) (b) may collect the repayment by deducting up to 20 per cent of the amount of the benefit from each payment of the benefit.  O. Reg. 403/96, s. 47 (5). (6) The insurer may charge interest on an amount repayable under this section from the fifteenth day after notice is given under subsection (2) at the bank rate in effect on that day.  O. Reg. 403/96, s. 47 (6). (7) In subsection (6), “bank rate” means the bank rate established by the Bank of Canada as the minimum rate at which the Bank of Canada makes short term advances to the banks listed in Schedule I to the Bank Act (Canada).  O. Reg. 403/96, s. 47 (7). Termination of Benefits for Material Misrepresentation
48. (1) If an insured person has wilfully misrepresented material facts with respect to an application for a benefit, the insurer may terminate payment of the benefit.  O. Reg. 403/96, s. 48 (1). (2) The insurer shall not terminate payment under subsection (1) unless the insurer provides the insured person with notice of the reasons for terminating payment.  O. Reg. 403/96, s. 48 (2). Right to Dispute
49. If an insurer refuses to pay a benefit under this Regulation or reduces the amount of a benefit that a person is receiving under this Regulation, the insurer shall provide the person with a written notice concerning the person’s right to dispute.  O. Reg. 281/03, s. 23. Restriction on Proceedings
50. (1) Subject to subsection (2), an insured person shall not apply to the Licence Appeal Tribunal under subsection 280 (2) of the Act if any of the following circumstances exist: 1.  The insured person has not notified the insurer of the circumstances giving rise to a claim for a benefit or submitted an application for the benefit within the times prescribed by this Regulation. 2.  If the insured person was required to undergo a designated assessment under section 43, the insured person has not undergone the designated assessment or has not complied with that section. O. Reg. 45/16, s. 5. (2) The Licence Appeal Tribunal may permit an insured person to apply despite paragraph 2 of subsection (1). O. Reg. 45/16, s. 5. (3) The Licence Appeal Tribunal may impose terms and conditions on a permission granted under subsection (2) of this section. O. Reg. 45/16, s. 5. Time Limit for Proceedings
51. An application under subsection 280 (2) of the Act in respect of a benefit shall be commenced within two years after the insurer’s refusal to pay the amount claimed. O. Reg. 45/16, s. 5. PART XI   DESIGNATED ASSESSMENT CENTRES Establishment of Designated Assessment Centres
52. The committee appointed under section 7 of the Insurance Act
shall, (a)  Revoked:  O. Reg. 546/05, s. 25. (b)  specify the types of impairments that each designated assessment centre is authorized to assess; and (c)  specify the types of assessments that each designated assessment centre is authorized to conduct.  O. Reg. 403/96, s. 52; O. Reg. 546/05, s. 25.
52.1 The committee referred to in section 52 may suspend, revoke or modify a designation under section 52, subject to such terms and conditions as the committee specifies.  O. Reg. 281/03, s. 25.
52.2 (1) When required by the committee referred to in section 52, every designated assessment centre shall provide the Superintendent with such information respecting the performance of its functions as the committee may require.  O. Reg. 281/03, s. 25. (2) Information required under subsection (1) shall be provided at such times and in such manner as the committee may determine and direct.  O. Reg. 281/03, s. 25. (3) The Superintendent shall review the information compiled under subsection (1) and may take such action in respect of the information as the Superintendent considers appropriate.  O. Reg. 281/03, s. 25. (4) If a designated assessment centre fails to comply with a request for information under subsection (1), the Superintendent may report the deficiency to the committee referred to in section 52.  O. Reg. 281/03, s. 25. Designated Assessment Centres
54. (1) A designated assessment centre that conducts an assessment under this Regulation of a person who sustains an impairment as a result of an accident shall not, after the assessment, provide any goods or services to the person in respect of the accident.  O. Reg. 403/96, s. 54 (1). (2) Subsection (1) does not apply if, (a)  the insured person and the insurer agree; or (b)  there is no other person within 50 kilometres of the insured person’s residence who is able to provide the goods or services.  O. Reg. 403/96, s. 54 (2). (3) Subsection (1) does not prevent the designated assessment centre from conducting another assessment of the person.  O. Reg. 403/96, s. 54 (3). PART XII   RESPONSIBILITY TO OBTAIN TREATMENT, PARTICIPATE IN REHABILITATION AND SEEK EMPLOYMENT Treatment and Rehabilitation
55. (1) An insured person entitled to an income replacement, non-earner or caregiver benefit shall obtain such treatment and participate in such rehabilitation as is reasonable, available and necessary to, (a)  permit the insured person to engage in employment that satisfies the criteria set out in subsection (2), in the case of an insured person entitled to an income replacement benefit; or (b)  shorten the period during which the benefit is payable, in any other case.  O. Reg. 403/96, s. 55 (1). (2) The criteria referred to in clause (1) (a) are: 1.  The insured person, i.  is able and qualified to perform the essential tasks of the employment, or ii.  would be able and qualified to perform the essential tasks of the employment if the insured person obtained treatment and participated in rehabilitation that is reasonable, available and necessary to permit the person to engage in the employment. 2.  The employment exists in the area in which the insured person lives. 3.  It would be reasonable to expect the insured person to engage in the employment having regard to the possibility of deterioration in the insured person’s impairment and to the insured person’s personal and vocational characteristics.  O. Reg. 403/96, s. 55 (2). (3) Subsection (1) does not apply if compliance with subsection (1) would be detrimental to the insured person’s treatment or recovery.  O. Reg. 403/96, s. 55 (3). (4) If an insured person does not comply with subsection (1), the insurer may notify the insured person that the insurer intends to stop payment of the benefit in accordance with subsection (5).  O. Reg. 281/03, s. 28. (5) If at least 10 business days have elapsed after a notice was given under subsection (4) and the insured person has not complied with subsection (1), the insurer may stop payment of the benefit.  O. Reg. 281/03, s. 28; O. Reg. 546/05, s. 26. (6) Section 37 does not apply in respect of a stoppage of benefits, or proposed stoppage of benefits, under this section.  O. Reg. 281/03, s. 28. (7) If, after the stoppage of benefits under subsection (5), the insured person subsequently complies with subsection (1), the insurer shall resume payment of the benefit in respect of periods after the insured person complied.  O. Reg. 281/03, s. 28. Employment
56. (1) An insured person who is entitled to an income replacement benefit shall make reasonable efforts to, (a)  return to the employment in which he or she engaged at the time of the accident; or (b)  obtain employment for which he or she is reasonably suited by education, training or experience.  O. Reg. 403/96, s. 56 (1). (2) Subsection (1) does not apply if, (a)  employment would be detrimental to the insured person’s treatment or recovery; or (b)  the insured person is participating in a vocational rehabilitation program.  O. Reg. 403/96, s. 56 (2). (3) If an insured person does not comply with subsection (1), the insurer may notify the insured person that the insurer intends to stop payment of the benefit in accordance with subsection (4).  O. Reg. 281/03, s. 29. (4) If at least 10 business days have elapsed after a notice is given under subsection (3) and the insured person is not in compliance with subsection (1), the insurer may stop payment of the benefit.  O. Reg. 281/03, s. 29; O. Reg. 546/05, s. 27. (5) Section 37 does not apply in respect of a stoppage of benefits, or proposed stoppage of benefits, under this section.  O. Reg. 281/03, s. 29. (6) If, after the stoppage of benefits under subsection (4), the insured person subsequently complies with subsection (1), the insurer shall resume payment of the benefit in respect of periods after the insured person complied.  O. Reg. 281/03, s. 29. PART XIII   INTERACTION WITH OTHER SYSTEMS Accidents outside Ontario
57. (1) If, as a result of an accident in another province or territory of Canada or a jurisdiction in the United States of America, a person insured in that jurisdiction dies or sustains an impairment or incurs an expense described in section 14, 15 or 16, the insurer shall pay, as the person may elect, (a)  benefits provided by this Regulation, other than the benefits referred to in clause (b); or (b)  benefits in the same amounts and subject to the same conditions as if the person was a resident of the jurisdiction in which the accident occurred and was entitled to payments under the law of that jurisdiction.  O. Reg. 403/96, s. 57 (1). (1.1) Subsection (1) does not apply if the person receives benefits under the law of the jurisdiction in which the accident occurred.  O. Reg. 462/96, s. 8 (1). (2) A person who elects to claim a benefit as provided in clause (1) (a) is thereafter eligible only for benefits referred to in that clause.  O. Reg. 403/96, s. 57 (2). (3) A person who elects to claim a benefit as provided in clause (1) (b) is thereafter ineligible for benefits referred to in clause (1) (a).  O. Reg. 403/96, s. 57 (3). (4) For the purpose of this section, a person is insured in the jurisdiction in which the accident occurred if the person, at the time of the accident, (a)  was authorized by law to be or to remain in Canada and was living and ordinarily present in Ontario; (b)  met the criteria prescribed for recovery under the law of the jurisdiction in which the accident occurred; (c)  was not the owner or driver of, or an occupant of an automobile registered in the jurisdiction in which the accident occurred; and (d)  was, (i)  an occupant of the insured automobile, (ii)  the named insured, a person specified in the policy as a driver of the insured automobile, the spouse of the named insured or a dependant of the named insured or spouse, while the occupant of any automobile, (iii)  a person who was not the occupant of an automobile and was struck by the insured automobile, (iv)  the named insured, his or her spouse or a dependant of the named insured or  spouse and was struck by any automobile, (v)  if the named insured is a corporation, unincorporated association, partnership or sole proprietorship, a person for whose regular use the insured automobile was supplied, his or her spouse or a dependant of the person or spouse who suffered an impairment, (A)  while the occupant of any automobile, (B)  by any automobile while not the occupant of the automobile, or (vi)  a person struck by an automobile that was driven by a person described in subclause (i), (ii) or (v).  O. Reg. 403/96, s. 57 (4); O. Reg. 462/96, s. 8 (2); O. Reg. 114/00, s. 6; O. Reg. 314/05, s. 6. Social Assistance Payments
58. (1) The insurer shall pay benefits under this Regulation even though the insured person is entitled to, or has received, benefits under an Act administered by the Ministry of Community and Social Services for Ontario or under similar legislation in another jurisdiction.  O. Reg. 403/96, s. 58 (1). (2) For the purpose of subsection (1), a service, benefit or entitlement provided under an Act, the administration of which was transferred from the Ministry of Community and Social Services to the Ministry of Health by order in council, shall be deemed to be provided under an Act administered by the Ministry of Community and Social Services for Ontario so long as the nature of the service, benefit or entitlement remains substantially the same as it was before the transfer.  O. Reg. 403/96, s. 58 (2). Workers’ Compensation Benefits
59. (1) The insurer is not required to pay benefits under this Regulation in respect of any insured person who, as a result of an accident, is entitled to receive benefits under any workers’ compensation law or plan.  O. Reg. 403/96, s. 59 (1). (2) Subsection (1) does not apply in respect of an insured person who elects to bring an action referred to in section 30 of the Workplace Safety and Insurance Act, 1997 so long as the election is not made primarily for the purpose of claiming benefits under this Regulation.  O. Reg. 403/96, s. 59 (2); O. Reg. 281/03, s. 30 (1). (3) If a person is entitled to receive benefits under this Regulation as a result of an election made under section 30 of the Workplace Safety and Insurance Act, 1997, no income replacement, caregiver or non-earner benefit is payable to the person in respect of any period of time before the person makes the election.  O. Reg. 403/96, s. 59 (3); O. Reg. 462/96, s. 9; O. Reg. 281/03, s. 30 (2). (4) If a person who would be entitled to benefits under this Regulation in the absence of subsection (1) elects to bring an action referred to in section 30 of the Workplace Safety and Insurance Act, 1997 and there is a dispute concerning the insurer’s liability to pay an expense for a vocational rehabilitation program that the person was attending at the time of the election and continues to attend, the insurer shall pay the expense pending resolution of the dispute.  O. Reg. 403/96, s. 59 (4); O. Reg. 281/03, s. 30 (3). (5) Despite subsection (1), if there is a dispute about whether subsection (1) applies to a person, the insurer shall pay full benefits to the person under this Regulation pending resolution of the dispute if, (a)  the person makes an assignment to the insurer of any benefits under any workers’ compensation law or plan to which he or she is or may become entitled as a result of the accident; and (b)  the administrator or board responsible for the administration of the workers’ compensation law or plan approves the assignment.  O. Reg. 403/96, s. 59 (5). Other Collateral Benefits
61. (1) For the purpose of this Regulation, a person’s net weekly income from employment shall be determined in accordance with the following formula: A = (B – C – D – E)/52 where, A =  the person’s net weekly income from employment, B =  the person’s gross annual income from employment, C =  the annual premium payable by the person under the Employment Insurance Act (Canada) on the gross annual income from employment, D =  the annual contribution payable by the person under the Canada Pension Plan on the gross annual income from employment, E =  the income tax payable by the person under the Income Tax Act (Canada) and the Income Tax Act (Ontario) on the gross annual income from employment. O. Reg. 403/96, s. 61 (1). (2) For the purpose of subsection (1), the person whose net weekly income from employment is to be determined shall be deemed to be a resident of Ontario.  O. Reg. 403/96, s. 61 (2). Income from Self-Employment
62. (1) For the purpose of this Regulation, a person’s income from self-employment shall be determined in the same manner as the person’s profit from the business in which the person was self-employed would be determined under the Income Tax Act (Canada) and the Income Tax Act (Ontario), but without taking into account, (a)  expenses that are eligible for capital cost allowance or an allowance on eligible capital property; (b)  capital gains or losses; or (c)  losses deductible under section 111 of the Income Tax Act (Canada).  O. Reg. 403/96, s. 62 (1). (2) Despite subsection (1), an insurer and a named insured who is self-employed and not otherwise employed may agree in a contract evidenced by a motor vehicle liability policy that, for the purpose of determining benefits under this Regulation in respect of an accident that occurs during the period covered by the contract, the named insured’s gross income from self-employment for every week shall be deemed to be the weekly income amount specified in the contract if, at the time of the accident, the person continues to engage in the self-employment in which he or she engaged at the time the contract was entered into and the person is not otherwise employed.  O. Reg. 403/96, s. 62 (2). (3) In specifying a weekly income amount for the purpose of subsection (2), the insurer and insured may use information from any source, including, (a)  personal and corporate income tax returns and assessments; (b)  personal and corporate financial statements; and (c)  published data on the average wage for the industry or occupation in which the insured is self-employed.  O. Reg. 403/96, s. 62 (3). Income Tax Calculations
63. (1) For the purpose of this Regulation, the income tax payable by a person under the Income Tax Act (Canada) and the Income Tax Act (Ontario) shall be determined having regard to only the following deductions and tax credits that apply to the person under those Acts: 1.  Alimony and maintenance payments deduction. 2.  Basic personal tax credit. 3.  Married person’s tax credit or equivalent to married tax credit. 4.  Age tax credit. 5.  Disability tax credit. 6.  Employment insurance premium tax credit. 7.  Canada Pension Plan tax credit. 8.  Quebec Pension Plan tax credit.  O. Reg. 403/96, s. 63 (1). (2) If a determination of the income tax payable by a person under the Income Tax Act (Canada) and the Income Tax Act (Ontario) is necessary to determine the amount of a benefit under this Regulation, the applicant for the benefit shall provide the insurer with such information as is reasonably necessary to enable the insurer to make the determination.  O. Reg. 462/96, s. 11. (3) Failure to comply with subsection (2) does not relieve the insurer from any time limit established by this Regulation for the payment of the benefit, but the insurer shall determine the amount of the benefit on the basis of its best estimate of the income tax payable by the person under the Income Tax Act
(Canada) and the Income Tax Act (Ontario), subject to later adjustment of the amount of the benefit when subsection (2) is complied with.  O. Reg. 403/96, s. 63 (3). Severance or Termination Pay
64. For the purpose of this Regulation, payments of severance pay or termination pay shall not be included in a determination of a person’s income.  O. Reg. 403/96, s. 64. Unreported Income
64.1 (1) If, under the Income Tax Act (Canada) or legislation of another jurisdiction that imposes a tax calculated by reference to income, a person is required to report the amount of his or her income, the person’s income before an accident that occurs after April 14, 2004 shall be determined for the purposes of this Regulation without reference to any income the person has failed to report contrary to that Act or legislation.  O. Reg. 458/03, s. 11. (2) Where the amount of a person’s income before an accident is determined for the purposes of this Regulation in accordance with subsection (1), the amount of the income may be adjusted to reflect any change in the amount of the person’s income reported or determined in accordance with the Income Tax Act (Canada) or legislation of another jurisdiction that imposes a tax calculated by reference to income.  O. Reg. 458/03, s. 11. PART XV   MISCELLANEOUS Assignment of Benefits
65. (1) Except as otherwise provided by subsection (2), the assignment of a benefit under this Regulation is void. O. Reg. 45/16, s. 6 (1). (2) Subsection (1) does not apply to, (a)  an assignment under section 267.8 of the Insurance Act; (b)  an assignment of a benefit to, (i)  the Ministry of Community, Family and Children’s Services, (ii)  a delivery agent under the Ontario Disability Support Program Act, 1997 or the Ontario Works Act, 1997, or (iii)  The Minister of Finance under subsection 6.1 (4) of the Motor Vehicle Accident Claims Act; or (c)  the assignment of a benefit to the Ministry of Health in respect of a service, benefit or entitlement provided under an Act the administration of which was transferred by order in council from the Ministry of Community and Social Services to the Ministry of Health.  O. Reg. 403/96, s. 65 (2); O. Reg. 281/03, s. 32. (3) If the assignment of a benefit to a person is void, (a)  subsection 280 (2) of the Act does not apply to the person; and (b)  subsection 280 (3) of the Act does apply to the person, but the exception in that subsection, which permits bringing a proceeding, does not apply to the person. O. Reg. 45/16, s. 6 (2). Company Automobiles and Rental Automobiles
66. (1) An individual who is living and ordinarily present in Ontario shall be deemed for the purpose of this Regulation to be the named insured under the policy insuring an automobile at the time of an accident if, at the time of the accident, (a)  the insured automobile is being made available for the individual’s regular use by a corporation, unincorporated association, partnership, sole proprietorship or other entity; or (b)  the insured automobile is being rented by the individual for a period of more than 30 days.  O. Reg. 403/96, s. 66 (1); O. Reg. 462/96, s. 12 (1). (2) An individual who is not living and ordinarily present in Ontario shall be deemed for the purpose of this Regulation to be the named insured under the policy insuring an automobile at the time of an accident if, at the time of the accident, (a) the insured automobile is being made available for the individual’s regular use by a corporation, unincorporated association, partnership, sole proprietorship or other entity; and (b)  the individual, his or her spouse or any dependant of the individual or spouse is an occupant of the insured automobile.  O. Reg. 403/96, s. 66 (2); O. Reg. 462/96, s. 12 (2); O. Reg. 114/00, s. 7; O. Reg. 314/05, s. 7. Copies of Regulation
67. On request, the insurer shall provide a copy of this Regulation without charge to a named insured or a person entitled to benefits under this Regulation.  O. Reg. 403/96, s. 67. Notices and Delivery
68.1 Any consent, notice or other thing to be given by or to an insured person under this Regulation may be given by or to a person exercising a power of decision on behalf of the insured person under the authority of the Substitute Decisions Act, 1992 or as authorized under the Health Care Consent Act, 1996.  O. Reg. 546/05, s. 29. Forms
69. Each of the following documents shall be in a form approved by the Superintendent: 1.  An application form referred to in clause 32 (2) (a). 2.  A disability certificate. 2.1  A consent under section 32.1. 2.2  A notice under subsection 35 (3) or (4). 3.  A notice under section 36. 4.  A notice under subsection 37.1 (5). 5.  A treatment confirmation form under section 37.1. 5.1  A notice under subsection 37.2 (2). 6.  An application referred to in section 38, including the treatment plan. 6.1  A notice under subsection 38 (8). 7.  An application under section 38.2. 7.1  A notice under subsection 38.2 (6). 7.2  A notice under section 39 advising an insured person that the insurer requires him or her to be examined under section 42. 8.  An application under subsection 40 (1). 9.  A notice under subsection 40 (2). 10.  A report of a designated assessment. 10.1  A notice under section 42. 10.2  An invoice in respect of an expense for goods or services specified in a Guideline issued for the purposes of section 44.1. 11.  An explanation under section 45. 12.  A notice under section 49.  O. Reg. 281/03, s. 34; O. Reg. 546/05, s. 30; O. Reg. 533/06, s. 14.
69.1 (1) Any document that is required by section 69 to be in a form approved by the Superintendent and to which subsection 68 (3.2) applies and any other document specified in a Guideline issued for the purposes of this section is duly completed and includes all information required by this Regulation to be included in it if, (a)  every field not identified on the form as an optional field is completed in accordance with subsection (2); and (b)  if any field on the form that is identified as an optional field is completed, it is completed in accordance with subsection (2).  O. Reg. 533/06, s. 15. (2) If the form specifies the manner or the format in which a field is to be completed, completion of the field shall be in that manner and in that format.  O. Reg. 533/06, s. 15. Transition
70. (1) Despite anything else in this Regulation, if a motor vehicle liability policy is in effect on the day this Regulation comes into force, subsections (2) and (3) apply until the earlier of the following: 1.  The first expiry date under the motor vehicle liability policy. 2.  The date on which the motor vehicle liability policy is terminated by the insurer or the insured.  O. Reg. 403/96, s. 70 (1). (2) The following benefits are deemed to be included in the motor vehicle liability policy, and are applicable to an insured person in respect of the motor vehicle liability policy: 1.  The optional income replacement benefit referred to in paragraph 1 of subsection 27 (1) that fixes the amount referred to in subparagraph ii of paragraph 2 of subsection 7 (1) at $1,000. 2.  The optional caregiver and dependant care benefit referred to in paragraph 2 of subsection 27 (1). 3.  The optional death and funeral benefit referred to in paragraph 4 of subsection 27 (1).  O. Reg. 403/96, s. 70 (2). (3) The sum of the medical, rehabilitation and attendant care benefits paid under the motor vehicle liability policy for any one accident in respect of an insured person who does not sustain a catastrophic impairment as a result of the accident shall not exceed $1,000,000, and the limits set out in clauses 19 (1) (a) and (2) (a) do not apply.  O. Reg. 403/96, s. 70 (3).
70.1 Form 1, as it read on September 30, 2003, continues to apply in respect of accidents occurring before October 1, 2003.  O. Reg. 281/03, s. 35.
71. Omitted (provides for coming into force of provisions of this Regulation).  O. Reg. 403/96, s. 71. Form 1 Revoked:  O. Reg. 546/05, s. 31.  Français