35. (1) In this section and section 37, “specified benefit” means an income replacement benefit, non-earner benefit, caregiver benefit or a payment for housekeeping or home maintenance services under section 22.  O. Reg. 546/05, s. 9. (2) An insured person who applies for a specified benefit shall submit with the application a disability certificate completed no earlier than 10 business days before the date the application is submitted.  O. Reg. 546/05, s. 9. (3) Within 10 business days after the insurer receives the application and completed disability certificate, the insurer shall, (a)  pay the specified benefit; (b)  send a request to the insured person under subsection 33 (1) or (1.1); or (c)  notify the insured person that the insurer requires the insured person to be examined under section 42.  O. Reg. 546/05, s. 9. (4) If the insurer sends a request to the insured person under subsection 33 (1) or (1.1), the insurer shall, within 10 business days after the insured person complies with the request, (a)  pay the specified benefit; or (b)  notify the insured person that the insurer requires the insured person to be examined under section 42.  O. Reg. 546/05, s. 9. (5) Every income replacement benefit, non-earner benefit or caregiver benefit shall be paid at least once every second week, subject to any prepayment of the benefit by the insurer.  O. Reg. 546/05, s. 9. (6) An insurer may make a determination that an insured person is not entitled to a specified benefit if, (a)  the insured person failed or refused to submit the completed disability certificate required under subsection (2); (b)  the insurer has received the report of the examination under section 42, if the insurer has required the insured person to be examined under that section; (c)  the insurer is entitled under subsection (10) to refuse to pay the specified benefit; or (d)  the insured person is not entitled to the specified benefit for reasons unrelated to whether the insured person has an impairment that entitles the insured person to the specified benefit.  O. Reg. 546/05, s. 9. (7) If an insurer determines that an insured person is not entitled to receive a specified benefit by reason of clause (6) (a), (c) or (d), the insurer shall give the insured person a copy of its determination, (a)  within 10 business days after receiving the application, if the insured person is not entitled to the specified benefit by reason of clause (6) (a) or (d); or (b)  within 10 business days after the insured person failed or refused to comply with subsection 42 (10), if the insured person is not entitled to the specified benefit by reason of clause (6) (c).  O. Reg. 546/05, s. 9. (8) Within five business days after receiving the report of the examination of the insured person under section 42, the insurer shall give a copy of the report and of the insurer’s determination to the insured person and to the health practitioner who completed the disability certificate submitted with the application.  O. Reg. 546/05, s. 9. (9) The insurer shall set out in its determination the specified benefits and expenses the insurer agrees to pay, the specified benefits and expenses the insurer refuses to pay and the reasons for the insurer’s decision.  O. Reg. 546/05, s. 9. (10) If the insured person fails or refuses to comply with subsection 42 (10), the insurer, (a)  may make a determination that the insured person is not entitled to any specified benefit; and (b)  may refuse to pay specified benefits relating to the period after the insured person failed or refused to comply with subsection 42 (10) and before the insured person submits to the examination or provides the material required by that subsection.  O. Reg. 546/05, s. 9. (11) If the insured person subsequently complies with subsection 42 (10), the insurer shall, (a)  reconsider the application and make a new determination under this section; and (b)  pay all amounts, if any, that were withheld during the period of non-compliance, if the insurer determines that the insured person is entitled to any specified benefits and 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 subsection 42 (10).  O. Reg. 546/05, s. 9. (12) If the insurer determines after receipt of the report under section 42 that the insured person is entitled to a specified benefit, the insurer shall pay the specified benefit within 10 business days after receiving the report.  O. Reg. 546/05, s. 9. (13) If an insured person fails to submit a completed disability certificate with his or her application for a specified benefit, no specified benefits are payable for the period after the day the insurer receives the application and before the day the insurer receives the completed disability certificate.  O. Reg. 546/05, s. 9. (14) If the insurer fails to provide a copy of the report of the examination under section 42 or its determination in respect of the claim by 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, the insurer shall pay all specified benefits to which the application relates for the period commencing on that day and ending on the day the insurer gives the insured person the report or determination.  O. Reg. 546/05, s. 9. Election of Income Replacement, Non-earner or Caregiver Benefit