Thursday, May 8, 2008

The following conditions must be satisfied for the purposes of paragraph 9 of subsection 24 (1):

1. The consulting fees must be charged by one of the following persons:

i. the health practitioner who prepared the disability certificate, if the examination relates to a claim in respect of which a disability certificate is required under this Regulation,

ii. The health practitioner who approved the treatment plan, if the examination relates to a claim for medical or rehabilitation benefits,

iii. The member of the health profession who prepared the assessment of attendant care needs, if the examination relates to an application under section 39, or

iv. The health practitioner who prepared the application, if the examination relates to an application under section 40 to assist the insurer determines whether the insured person has sustained a catastrophic impairment.

2. The consultation must be arranged by mutual agreement of the person who is conducting or has conducted the examination under section 42 and the health practitioner or member of the health profession involved in the consultation.

3. The fees must be reasonable and, subject to subsection (2), shall not exceed the amount ordinarily charged for a 30 minute professional consultation by telephone. O. Reg. 546/05, s. 4.

(2) If under a Guideline a maximum rate or amount for expenses is established that applies to the claim with respect to which the examination under section 42 and consultation relate and the payment of the fees for the consultation would result in the expenses exceeding this maximum rate or amount, only the portion of the fees for the consultation that would not result in the expenses for the claim exceeding the maximum rate or amount shall be paid. O. Reg. 546/05, s. 4.

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