(1.1) A person shall notify the insurer under subsection (1) no later than,
(a) the 30th day after the circumstances arose that gave rise to the entitlement to the benefit, or as soon as practicable after that day, if those circumstances arose as a result of an accident that occurred before October 1, 2003; or
(b) The seventh day after the circumstances arose that give rise to the entitlement to the benefit, or as soon as practicable after that day, if those circumstances arose as a result of an accident that occurred on or after October 1, 2003. O. Reg. 281/03, s. 11 (1).
(2) The insurer shall promptly provide the person with,
(a) The appropriate application forms;
(b) a written explanation of the benefits available under this Regulation;
(c) Information to assist the person in applying for benefits; and
(d) Information on any possible elections relating to income replacement, non-earner and caregiver benefits. O. Reg. 403/96, s. 32 (2).
(2.1) If an insurer that is subject to a Guideline referred to in subsection 68 (3.2) determines, acting reasonably that there is a likelihood that the person may, in connection with the accident, deliver one or more documents referred to in subsection 68 (3.2), the insurer shall provide the following information to the central processing agency referred to in that subsection:
1. The name, address, gender and date of birth of the person.
2. The date of the accident.
3. Particulars of the automobile insurance policy under which the person alleges he or she is entitled to a benefit or benefits, including,
i. the name of the insurer,
ii. the policy number, and
iii. the name of the person to whom the policy was issued.
4. The claim number assigned by the insurer.
5. Any other information reasonably required by the central processing agency to enable it to carry out its obligations to the insurer under this Regulation. O. Reg. 533/06, s. 3.
(2.2) An insurer’s obligation to provide the information referred to in subsection (2.1) may be discharged by,
(a) Providing the information to the central processing agency; or
(b) Confirming, correcting or supplementing the information previously provided to the central processing agency. O. Reg. 533/06, s. 3.
(3) The person shall submit a signed application for the benefit to the insurer within 30 days after receiving the application forms. O. Reg. 403/96, s. 32 (3); O. Reg. 533/06, s. 4 (1).
(3.1) If an insurer receives an incomplete application for a benefit under this Regulation, the insurer shall notify the person within 10 business days after receiving the incomplete application that the application is incomplete and shall indicate what is missing. O. Reg. 281/03, s. 11 (2); O. Reg. 546/05, s. 5 (1); O. Reg. 533/06, s. 4 (2).
(3.2) Subsection (3.1) applies only if,
(a) the insurer, after a reasonable review of the incomplete application, is unable to determine without the missing information if a benefit is payable; or
(b) the application has not been signed by the person. O. Reg. 533/06, s. 4 (3).
(4) If a person is required by an insurer to submit an additional application in respect of a benefit that the person is receiving or may be eligible to receive, the person shall submit the additional application to the insurer within 30 days after receiving the additional application forms from the insurer. O. Reg. 403/96, s. 32 (4).
(5) If subsection (3.1) applies in respect of an incomplete application, no benefit is payable before the person provides the missing information or signs the application, as the case may be. O. Reg. 281/03, s. 11 (2); O. Reg. 533/06, s. 4 (4).
(6) Despite any shorter time limit in this Regulation, if a person fails without a reasonable explanation to notify an insurer under subsection (1) within the time required under subsection (1.1), the insurer may delay determining if the person is entitled to a benefit under section 35, 38, 39 or 41 and may delay paying the benefit until the later of,
(a) 45 days after the day the insurer receives the person’s application; or
(b) 10 business days after the day the person complies with any request made by the insurer under subsection 33 (1) or (1.1). O. Reg. 546/05, s. 5 (2).
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