37.1 (1) This section applies if an insured person, (a)  submits or intends to submit an application for a benefit in accordance with section 32; and (b)  claims medical or rehabilitation benefits in respect of an impairment that comes within a Pre-approved Framework Guideline.  O. Reg. 281/03, s. 15. (2) The insured person shall submit to the insurer, within the time specified in the Pre-approved Framework Guideline applicable to the impairment, a treatment confirmation form that satisfies the following requirements: 1.  The treatment confirmation form shall be prepared by a health practitioner who is authorized by law to treat the impairment that is the subject of the form and who will be the health practitioner responsible for providing goods and services under the treatment confirmation form. 2.  The treatment confirmation form shall contain details concerning the impairment and specify the Pre-approved Framework Guideline under which benefits are claimed. 3.  The treatment confirmation form shall include a statement by the health practitioner who prepared the form, i.  disclosing any conflict of interest that he or she has that relates to the goods or services to be provided under the Pre-approved Framework Guideline, ii.  confirming that he or she has made reasonable inquiries to determine if any person who referred the insured person to a person who will provide goods or services under the Pre-approved Framework Guideline has a conflict of interest relating to the treatment, and iii.  disclosing any conflict of interest that a person who referred the insured person to a person who will provide goods or services under the Pre-approved Framework Guideline has that relates to the treatment. 4.  The treatment confirmation form shall be signed by the insured person, unless the insurer waives this requirement.  O. Reg. 281/03, s. 15; O. Reg. 533/06, s. 5. (3) A lawyer or other representative who acts for the insured person in respect of the application for a benefit or in respect of any civil proceeding arising from the accident shall, at the time the treatment confirmation form is submitted, give the insurer and the insured person written notice disclosing any conflict of interest that the lawyer or representative has relating to the claim for benefits.  O. Reg. 281/03, s. 15. (4) If a conflict of interest is disclosed in the treatment confirmation form or by a person under subsection (3), the insurer may refuse the application.  O. Reg. 281/03, s. 15. (5) Within five business days after receiving a treatment confirmation form, the insurer shall send a notice that complies with the following rules to the insured person and to the health practitioner, acknowledging receipt of the treatment confirmation form: 1.  The notice shall state whether the policy referred to in the treatment confirmation form was in force at the time of the accident. 2.  If the insurer refuses the application by reason of a conflict of interest, the notice shall state the reason the application is refused, what the conflict of interest is and that the insured person may submit a new application. 3.  If the treatment confirmation form includes a claim for ancillary goods or services referred to in section 37.2, the notice shall comply also with the requirements of that section.  O. Reg. 281/03, s. 15. (6) Despite subsection (4), the insurer shall not refuse an 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 provide the goods or services to which the conflict of interest relates.  O. Reg. 281/03, s. 15. (7) If an insured person submits an application under section 32 and a treatment confirmation form under this section in respect of an impairment and the claim is accepted by the insurer, the insurer is liable to pay benefits of a type described in section 14 or 15 in respect of the impairment only in accordance with, (a)  the Pre-approved Framework Guideline to which the treatment confirmation form relates; and (b)  the requirements of section 37.2, if that section applies in respect of the claim.  O. Reg. 281/03, s. 15. (8) If the insured person has submitted an application under section 32 to the insurer, the insurer shall pay a benefit referred to in subsection (7) within 30 days after receiving an invoice for goods or services, (a)  that have been provided under the Pre-approved Framework Guideline
to which the treatment confirmation form relates; (b)  that the insurer has agreed under section 37.2 to pay for and that have been provided; or (c)  that the insurer is required under subsection 37.2 (9) to pay for and that have been provided.  O. Reg. 281/03, s. 15; O. Reg. 546/05, s. 12 (1). (9) An insurer is not liable to pay benefits under more than one treatment confirmation form relating to the same Pre-approved Framework Guideline.  O. Reg. 281/03, s. 15. (10) An insured person may receive benefits under two or more Pre-approved Framework Guidelines if permitted under the Guidelines.  O. Reg. 281/03, s. 15. (11) An insured person shall submit an amended treatment confirmation form if, during the course of treatment under a Pre-approved Framework Guideline, he or she changes the health practitioner who is responsible for providing goods and services under the treatment confirmation form.  O. Reg. 281/03, s. 15. (12) The insurer is liable to pay for goods and services under an amended treatment confirmation form only to the extent the goods and services have not already been provided under the Pre-approved Framework Guideline.  O. Reg. 281/03, s. 15. (13) Revoked:  O. Reg. 546/05, s. 12 (2). (14) If goods or services available under a Pre-approved Framework Guideline
are not provided within the times specified in the applicable Guideline, any claim for medical or rehabilitation benefits to which the Guideline would otherwise apply shall, subject to section 37.2, be submitted in accordance with section 38.  O. Reg. 281/03, s. 15. (15) If it is determined in any dispute about an insured person’s entitlement to medical or rehabilitation benefits or related assessments or examinations that a Pre-approved Framework Guideline applies to the insured person and the insured person received benefits or underwent assessments or examinations under the Pre-approved Framework Guideline, (a)  the benefits shall be deemed to have been reasonable and necessary for the purposes of sections 14 and 15; and (b)  the assessments and examinations shall be deemed to have been reasonably required for the purposes of section 24.  O. Reg. 281/03, s. 15; O. Reg. 45/16, s. 1.