43. (1) The following rules apply if a designated assessment is required under this Regulation: 1.  The insurer shall notify the designated assessment centre within five business days. 2.  The insured person and the insurer shall provide the person or persons who will conduct the designated assessment with such information as is reasonably necessary, within the same period of five business days referred to in paragraph 1. 3.  The designated assessment centre shall promptly notify the insured person and arrange for the designated assessment. 4.  The insured person shall submit to all reasonable physical, psychological, mental and functional examinations requested by the person or persons who conduct the designated assessment.  O. Reg. 281/03, s. 21. (2) The following rules apply if an insured person does not submit to a designated assessment arranged under subsection (1) or fails to comply with paragraph 2 or 4 of subsection (1): 1.  The insurer may stop payment of the benefit related to the designated assessment until the insured person submits to the designated assessment and complies with paragraphs 2 and 4 of subsection (1). 2.  No benefit is payable for the period after the insured person fails to submit to the designated assessment or fails to comply with paragraph 2 or 4 of subsection (1) and before the insured person subsequently submits to an examination under subsection (1) and complies with paragraphs 2 and 4 of subsection (1).  O. Reg. 281/03, s. 21. (3) If an insured person subsequently submits to a designated assessment and is in compliance with paragraphs 2 and 4 of subsection (1), the insurer, (a)  shall resume payment of the benefit; and (b)  shall pay all amounts that were withheld during the period of non-compliance, if the insured person provides a reasonable explanation for not submitting to the designated assessment or not complying with paragraph 2 or 4 of subsection (1), as the case may be.  O. Reg. 281/03, s. 21. (4) After conducting the designated assessment, the person or persons who conducted the designated assessment shall prepare a report and provide a copy of the report to, (a)  the insurer; (b)  the insured person; and (c)  the insured person’s health practitioner.  O. Reg. 281/03, s. 21. (5) Subject to subsection (11), the designated assessment centre shall deliver the report within 14 days after the completion of the designated assessment.  O. Reg. 281/03, s. 21. (6) If the designated assessment is required under section 37 in respect of a claim for an income replacement, non-earner or caregiver benefit, the report of the designated assessment shall include a statement as to whether the insured person continues to have a disability that entitles the insured person to continue to receive the benefit.  O. Reg. 281/03, s. 21. (7) If the designated assessment is required under section 37.2, the report of the designated assessment shall state whether the ancillary goods and services claimed in the treatment confirmation form are reasonable and necessary.  O. Reg. 281/03, s. 21. (8) If the designated assessment is required under section 38, the report of the designated assessment shall, (a)  state whether the goods or services to be provided under the treatment plan are reasonable and necessary and shall include recommendations relating to the future provision of goods and services to the insured person for his or her treatment and rehabilitation, if the purpose of the designated assessment is to determine if the goods and services are reasonable and necessary; and (b)  state whether the impairment comes within a Pre-approved Framework Guideline, if the purpose of the designated assessment is to determine if the insured person has an impairment to which a Pre-approved Framework Guideline
applies.  O. Reg. 281/03, s. 21. (9) In the case of a designated assessment described in clause (8) (b), the report of the designated assessment centre shall also state whether the goods or services to be provided under the treatment plan are reasonable and necessary and shall include recommendations relating to the future provision of goods and services to the insured person for his or her treatment and rehabilitation, if the report states that the impairment does not come within a Pre-approved Framework Guideline.  O. Reg. 281/03, s. 21. (10) If the designated assessment is required under section 38.2, the report of the designated assessment shall state whether an expense in respect of an assessment or examination is payable under section 24.  O. Reg. 281/03, s. 21. (11) Despite subsection 53 (9), if the designated assessment is conducted to determine whether there are medical or rehabilitation benefits payable otherwise than under a Pre-approved Framework Guideline or the designated assessment is required under section 38.2, the designated assessment centre shall deliver its report to the insured person and the insurer within five business days after the later of, (a)  the day it receives the information required to be provided under paragraph 2 of subsection (1); or (b)  the day any conflict of interest disclosed by the designated assessment centre under section 53 in respect of the designated assessment is resolved under that section.  O. Reg. 281/03, s. 21. (12) If an insurer fails to give a notice required under subsection (1) in accordance with that subsection, the insurer shall pay for the goods and services that are the subject of the designated assessment and that relate to the period commencing on the day the insurer was required to give the notice and ending on the day the insurer gives the notice.  O. Reg. 281/03, s. 21. (13) If the designated assessment is required under section 39 in respect of a claim for an attendant care benefit, the report shall include, (a)  an assessment of attendant care needs; and (b)  recommendations on the future provision of attendant care services to the insured person.  O. Reg. 281/03, s. 21; O. Reg. 546/05, s. 22. (14) If the designated assessment is required under section 40 to determine whether an impairment is a catastrophic impairment, the report shall include a statement of whether, in the opinion of the person or persons who conducted the designated assessment, the impairment is a catastrophic impairment.  O. Reg. 281/03, s. 21. Method of Payment