47. (1) If an insured person sustains an impairment as a result of an accident, the insurer shall pay for all reasonable expenses incurred by or on behalf of the insured person as a result of the accident for, (a)  services provided by an aide or attendant; or (b)  services provided by a long-term care facility, including a nursing home, home for the aged or chronic care hospital.  O. Reg. 776/93, s. 47 (1). (2) For the purposes of clause (1) (a), an aide or attendant may be any person who is capable of providing the services, including a family member of the insured person, even if the aide or attendant does not possess any special qualifications.  O. Reg. 776/93, s. 47 (2). (3) Subsection (1) does not apply to expenses for which payment may be obtained under clause 36 (1) (g) or 40 (5) (d).  O. Reg. 776/93, s. 47 (3). (4) Subject to subsections (5) to (7), the maximum amount payable under this section in respect of an insured person is $3,000 per month.  O. Reg. 776/93, s. 47 (4). (5) If, as a result of the accident, the insured person suffers cervical spinal cord injuries, severe brain injuries or an upper bilateral amputation or other injuries that cause the total loss of use of both hands or arms, the maximum amount payable under this section in respect of the insured person is $6,000 per month.  O. Reg. 776/93, s. 47 (5). (6) If, as a result of the accident, the insured person suffers injuries mentioned in subsection (5) and another injury that by itself would have required services referred to in subsection (1), the maximum amount payable under this section in respect of the insured person is $10,000 per month.  O. Reg. 776/93, s. 47 (6). (7) If, as a result of the accident, the insured person suffers severe brain injuries that cause violent behaviour that may result in physical harm to the insured person or other persons, the maximum amount payable under this section in respect of the insured person is $10,000 per month.  O. Reg. 776/93, s. 47 (7). (8) For the purposes of this section, brain injuries are severe brain injuries only if, within a reasonable period after the accident, the person scored nine points or less on the Glasgow Coma Scale as published in Management of Head Injuries, Contemporary Neurology series, Volume 20, (F.A. Davis Company, 1981).  O. Reg. 776/93, s. 47 (8); O. Reg. 781/94, s. 12 (1). (9) The benefits payable to an insured person under this section shall be determined in accordance with the Form for Assessment of Attendant Care Needs - Accidents After December 31, 1993 and Before November 1, 1996 and subsection 50 (6).  O. Reg. 781/94, s. 12 (2); O. Reg. 26/06, s. 21; O. Reg. 46/16, s. 11. Certificate

48. (1) The insurer may require a person claiming payment of an expense under section 47 to furnish a certificate from a member of a health profession who is authorized by law to treat the person’s impairment stating that the expense is reasonable and is necessary for the person’s care.  O. Reg. 776/93, s. 48 (1). (2) In the case of an expense that is of a continuing nature, the insurer may require a certificate to be furnished under subsection (1) as often as reasonably necessary.  O. Reg. 776/93, s. 48 (2). Designated Assessment Centres (Attendant Care)

49. (1) The Superintendent may, for the purpose of this Part, (a)  Revoked:  O. Reg. 26/06, s. 22 (1). (b)  specify the types of impairments that each designated assessment centre is authorized to assess.  O. Reg. 776/93, s. 49 (1); O. Reg. 304/98, s. 4; O. Reg. 26/06, s. 22 (1). (2) The accident benefits advisory committee appointed under section 7 of the Insurance Act may, for the purpose of this Part, establish procedures, standards and guidelines that shall be used by designated assessment centres in conducting assessments.  O. Reg. 776/93, s. 49 (2). (3) In this Part, “designated assessment centre” means an assessment centre designated before March 1, 2006 by the Superintendent under clause (1) (a), as it read before March 1, 2006.  O. Reg. 26/06, s. 22 (2). Examination

50. (1) The insured person may, by written notice to the insurer, elect to be examined under section 65.  O. Reg. 26/06, s. 23. (2) If an insurer receives a certificate under section 48 in respect of an expense, the insurer may give the insured person notice requiring the insured person to be examined under section 65.  O. Reg. 26/06, s. 23. (3) Despite subsections (1) and (2), an insured person shall not be examined under section 65 within 12 months after the last assessment under this section, as it read before March 1, 2006, or the last examination under section 65 relating to services referred to in section 47.  O. Reg. 26/06, s. 23. (4) If the insured person elects to be examined or the insurer requires the insured person to be examined, the insurer shall provide to the insured person 14 days notice of the examination and 14 days notice of the examination shall be considered to be reasonable notice of the examination for the purposes of subsection 65 (2).  O. Reg. 26/06, s. 23. (5) Within 14 days of receipt of the report of examination, the insurer shall give the insured person notice of the amount to be paid by the insurer to the insured person for the future provision of services referred to in section 47.  O. Reg. 26/06, s. 23. (6) The determination under subsection (5) shall be made in accordance with the Form for Assessment of Attendant Care Needs - Accidents After December 31, 1993 and Before November 1, 1996 and shall be based on the following hourly rates for services: 1.  For care described in Part I of the Form for Assessment of Attendant Care Needs - Accidents After December 31, 1993 and Before November 1, 1996, $11.08 per hour. 2.  For care described in Part II of the Form for Assessment of Attendant Care Needs - Accidents After December 31, 1993 and Before November 1, 1996, the minimum hourly wage for the period to which the payment relates, as prescribed under the Employment Standards Act, 2000. 3.  For care described in Part III of the Form for Assessment of Attendant Care Needs - Accidents After December 31, 1993 and Before November 1, 1996, $17.72 per hour.  O. Reg. 26/06, s. 23; O. Reg. 46/16, s. 12. Payment of Benefits

50.1 (1) Subject to subsection 65 (5), an insurer shall mail or deliver a benefit that is payable under this Part to the person entitled within 14 days after the insurer receives an application for the benefit.  O. Reg. 781/94, s. 14. (2) An amount payable under this Part is overdue if the insurer fails to comply with subsection (1).  O. Reg. 781/94, s. 14. (3) If, before payment becomes overdue under subsection (2), the insurer requires that a certificate be furnished under subsection 48 (1) in respect of the benefit, (a)  subsections (1) and (2) do not apply; (b)  the insurer shall mail or deliver the benefit to the person entitled within 14 days after the insurer receives the certificate; and (c)  the amount payable becomes overdue if the insurer fails to comply with clause (b).  O. Reg. 781/94, s. 14. (4) When a benefit is paid under this Part, the insurer shall provide the insured person with a written explanation of how the amount of the benefit was determined.  O. Reg. 781/94, s. 14. (5) If the insurer refuses to pay a benefit under this Part, it shall give the insured person notice of the reasons for the refusal within 14 days after the insurer receives the report of the examination under section 65.  O. Reg. 26/06, s. 24. Transitional