Pre-claim Examination

(1) This section applies if,

(a) as a result of an accident, an insured person was admitted to a hospital or long-term care facility and is still in the hospital or facility or was discharged within the previous three days;

(b) the insured person may be entitled to medical benefits for an assistive device referred to in clause 14 (2) (f), rehabilitation benefits under clause 15 (5) (i) or attendant care benefits under section 16; and

(c) no application has yet been made for a benefit to which the insured person may be entitled as a result of the accident. O. Reg. 546/05, s. 6.

(2) At the insured person’s request or with his or her consent, the insurer may arrange for the insured person to be examined at the insurer’s expense for the purposes of assisting the insurer in determining if the insured person is entitled to receive a benefit described in clause (1) (b) that would assist the insured person after his or her discharge from the hospital or long-term care facility. O. Reg. 546/05, s. 6.

(3) An examination under this section shall be conducted by one or more members of one or more health professions who are chosen by the insurer. O. Reg. 546/05, s. 6.

(4) The insurer shall notify the insured person of the name of the person or persons who will conduct the examination and the day, time and place for the examination. O. Reg. 546/05, s. 6.

(5) The insurer shall, before the examination, obtain the written and signed consent of the insured person for the examination. O. Reg. 546/05, s. 6.

(6) The person or persons who conducted the examination shall, within five business days after conducting the examination, prepare a written report and, if applicable, an assessment of attendant care needs and provide a copy to,

(a) the insurer;

(b) the insured person; and

(c) if the insured person has a health practitioner, that health practitioner. O. Reg. 546/05, s. 6.

(7) An examination under this section is voluntary and any failure or refusal of an insured person to consent to an examination under this section does not affect any rights the insured person may have to apply for or receive benefits as a result of the accident. O. Reg. 546/05, s. 6.

(8) The report of an examination under this section shall not be relied on by an insurer in making a determination that an insured person is not entitled to a benefit under this Regulation. O. Reg. 546/05, s. 6.