Treatment and Rehabilitation

(1) An insured person entitled to an income replacement; non-earner or caregiver benefit shall obtain such treatment and participate in such rehabilitation as is reasonable, available and necessary to,

(a) permit the insured person to engage in employment that satisfies the criteria set out in subsection (2), in the case of an insured person entitled to an income replacement benefit; or

(b) Shorten the period during which the benefit is payable, in any other case. O. Reg. 403/96, s. 55 (1).

(2) The criteria referred to in clause (1) (a) are:

1. The insured person,

i. is able and qualified to perform the essential tasks of the employment, or

ii. Would be able and qualified to perform the essential tasks of the employment if the insured person obtained treatment and participated in rehabilitation that is reasonable, available and necessary to permit the person to engage in the employment.

2. The employment exists in the area in which the insured person lives.

3. It would be reasonable to expect the insured person to engage in the employment having regard to the possibility of deterioration in the insured person’s impairment and to the insured person’s personal and vocational characteristics. O. Reg. 403/96, s. 55 (2).

(3) Subsection (1) does not apply if compliance with subsection (1) would be detrimental to the insured person’s treatment or recovery. O. Reg. 403/96, s. 55 (3).

(4) If an insured person does not comply with subsection (1), the insurer may notify the insured person that the insurer intends to stop payment of the benefit in accordance with subsection (5). O. Reg. 281/03, s. 28.

(5) If at least 10 business days have elapsed after a notice was given under subsection (4) and the insured person has not complied with subsection (1), the insurer may stop payment of the benefit. O. Reg. 281/03, s. 28; O. Reg. 546/05, s. 26.

(6) Section 37 does not apply in respect of a stoppage of benefits, or proposed stoppage of benefits, under this section. O. Reg. 281/03, s. 28.

(7) If, after the stoppage of benefits under subsection (5), the insured person subsequently complies with subsection (1), the insurer shall resume payment of the benefit in respect of periods after the insured person complied. O. Reg. 281/03, s. 28.