37. (1) If an insurer wishes to determine if an insured person is still entitled to a specified benefit, the insurer, (a)  shall request that the insured person submit within 15 business days a new disability certificate completed as of a date on or after the date of the request; and (b)  may notify the insured person that the insurer requires the insured person to be examined under section 42.  O. Reg. 546/05, s. 11. (2) An insurer shall not discontinue paying a specified benefit to an insured person unless, (a)  the insured person fails or refuses to submit a completed disability certificate as required under clause (1) (a); (b)  the insurer has received the report of the examination under section 42, if the insurer required the insured person to be examined under that section; (c)  the insurer is entitled under subsection (7) to refuse to pay the specified benefit; (d)  the insured person has resumed his or her pre-accident employment duties; (e)  the insurer is no longer required to pay the specified benefit by reason of clause 5 (2) (d) or (e), subsection 22 (3) or 33 (2) or section 55 or 56; or (f)  the insured person is not entitled to the specified benefit for a reason unrelated to whether he or she has an impairment that entitles the insured person to receive the specified benefit.  O. Reg. 546/05, s. 11. (3) If an insured person fails to submit a completed disability certificate as required under clause (1) (a), no specified benefits are payable for the period commencing the 15th business day after the day the insured person received the insurer’s request and ending, if the insured person subsequently submits a completed disability certificate, the day the insurer receives the completed disability certificate.  O. Reg. 546/05, s. 11. (4) If the insurer determines that the person is not entitled to receive any specified benefit by reason of clause (2) (a), (c), (d), (e) or (f), the insurer shall give to the insured person a copy of its determination.  O. Reg. 546/05, s. 11. (5) 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 specified benefit to the insured person and to the health practitioner who completed the disability certificate.  O. Reg. 546/05, s. 11. (6) The determination of the insurer shall specify, (a)  the specified benefits and expenses the insurer agrees to pay; (b)  the specified benefits and expenses the insurer refuses to pay; (c)  the reasons for the insurer’s decision; and (d)  if the insurer determines that the insured person is not entitled to a specified benefit, the date that payment of the benefit will be stopped.  O. Reg. 546/05, s. 11. (7) If the insured person fails or refuses to comply with subsection 42 (10), the insurer may, (a)  make a determination that the insured person is no longer entitled to the specified benefit; and (b)  despite subsection (9), 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 under that subsection.  O. Reg. 546/05, s. 11. (8) If the insured person subsequently complies with subsection 42 (10), the insurer shall, (a)  reconsider the insured person’s entitlement to the specified benefit and make a determination; (b)  subject to the insurer’s determination, resume payment of the specified benefit; and (c)  pay all amounts, if any, that were withheld during the period of non-compliance if 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. 11. (9) If an insurer requires an insured person to be examined under section 42 and determines that the insured person is not entitled to a specified benefit, the insurer shall not stop payment of the specified benefit unless it has provided to the insured person a copy of the report of the examination and its determination under this section.  O. Reg. 546/05, s. 11. Pre-approved Framework Guidelines