42. (1) If it is more reasonable to purchase a new vehicle to accommodate the needs of an insured person than to modify an existing vehicle, the insurer shall contribute to the cost of a new vehicle in an amount equal to the cost of the new vehicle, less the trade-in value of the existing vehicle.  O. Reg. 776/93, s. 42 (1). (2) Expenses incurred to purchase or modify a vehicle to accommodate the needs of an insured person shall be deemed not to be reasonable expenses for the purposes of this Part if they are incurred within five years after the last expenses incurred for that purpose in respect of the same accident.  O. Reg. 776/93, s. 42 (2). Certificate

43. (1) The insurer may require a person claiming payment of an expense under section 40 to furnish one of the following certificates, as selected by the person claiming payment: 1.  A certificate from the person’s physician stating that the expense is reasonable and is necessary for the person’s rehabilitation. 2.  A certificate from the person’s chiropractor or psychologist stating that the expense is reasonable and is necessary for the person’s rehabilitation, if the impairment is one that the chiropractor or psychologist is authorized by law to treat. 3.  A certificate from the person’s physician or, if the impairment is one that a psychologist is authorized by law to treat, the person’s psychologist, stating that, i.  a member of a health profession, other than a physician or psychologist, has expressed in writing the opinion that the expense is reasonable and is necessary for the person’s rehabilitation, and ii.  the physician or psychologist does not disagree with the opinion.  O. Reg. 776/93, s. 43 (1). (2) Subsection (1) does not apply to an expense under clause 40 (5) (c) or an expense for a vocational rehabilitation program referred to in subsection 76 (4).  O. Reg. 776/93, s. 43 (2). (3) If a physician or psychologist signs a certificate under paragraph 3 of subsection (1), he or she shall attach to the certificate the written opinion of the member of the health profession.  O. Reg. 776/93, s. 43 (3). (4) 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. 43 (4). Designated Assessment Centres (Medical and Rehabilitation)

44. The assessment centres designated before March 1, 2006 for the purpose of Part VII shall be deemed to have been designated for the purpose of this Part and, (a)  the Superintendent may, for the purpose of this Part, specify the types of impairments that each designated assessment centre is authorized to assess; and (b)  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. 44; O. Reg. 304/98, s. 3; O. Reg. 26/06, s. 17. Examination

45. (1) If the insurer receives a certificate under section 43 in respect of an expense, the insurer may give the insured person a notice requiring the insured person to be examined under section 65.  O. Reg. 26/06, s. 18 (1). (2) Subsection (1) does not apply to an expense under clause 40 (5) (c) or (d) or an expense for a vocational rehabilitation program referred to in subsection 76 (4).  O. Reg. 776/93, s. 45 (2). (3) If the insurer requires the insured person to be examined under section 65, the insurer shall provide the insured person with 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. 18 (2). (4) Subject to the determination of a dispute described in subsection 280 (1) of the Act relating to the expense, the insurer is not required to pay an expense if the insurer has received the report of the examination under section 65 and gives notice under subsection 45.1 (6) that it refuses to pay the expense. O. Reg. 46/16, s. 10. (5)-(12) Revoked:  O. Reg. 26/06, s. 18 (2). Payment of Benefits

45.1 (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. 11. (2) An amount payable under this Part is overdue if the insurer fails to comply with subsection (1).  O. Reg. 781/94, s. 11. (3) If, before payment becomes overdue under subsection (2), the insurer requires that a certificate be furnished under subsection 43 (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. 11. (4) If, before payment becomes overdue under clause (3) (b) in respect of an expense under section 40, the insurer requires an examination under section 65, (a)  subsections (1), (2) and (3) do not apply; (b)  the insurer shall, (i)  mail or deliver the payment of the expense to the person entitled within 14 days after the insurer receives the report of the examination under section 65, or (ii)  give the person a notice in accordance with subsection (6) if the insurer refuses to pay the expense; and (c)  the amount payable becomes overdue if the insurer fails to comply with clause (b).  O. Reg. 781/94, s. 11; O. Reg. 26/06, s. 19 (1, 2). (5) 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. 11. (6) 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. 19 (3). Transitional

45.2 (1) Subsection 40 (7) and sections 45 and 45.1, as they read on February 28, 2006, continue to apply in respect of a claim for payment of an expense under section 40 if, before March 1, 2006, an insurer has given a notice to the insured person under subsection 45 (1), as it read on February 28, 2006, requiring the insured person to be assessed.  O. Reg. 26/06, s. 20. (2) Despite subsection (1), if an assessment of an insured person by a designated assessment centre cannot be conducted or completed on or after March 1, 2006 because there is no designated assessment centre that satisfies the requirements of this Part, the insurer may give the insured person a notice in writing requiring the insured person to be examined under section 65 in respect of the claim, instead of being assessed by a designated assessment centre, and the provisions of this Regulation, as they read after February 28, 2006, apply in respect of the disposition of the claim after the notice is given.  O. Reg. 26/06, s. 20. PART IX   MAXIMUM LIMIT ON SUPPLEMENTARY MEDICAL BENEFITS AND REHABILITATION BENEFITS

46. (1) The total of all benefits paid under Parts VII and VIII in respect of an insured person shall not exceed $1,000,000 in respect of any one accident.  O. Reg. 776/93, s. 46 (1). (2) The maximum limit applicable under subsection (1) shall be the maximum limit that was in effect on the date of the accident, even if the maximum limit has been revised under section 80.  O. Reg. 776/93, s. 46 (2). PART X   ATTENDANT CARE BENEFITS Entitlement to Benefits