(1) If an insured person has willfully misrepresented material facts with respect to an application for a benefit, the insurer may terminate payment of the benefit. O. Reg. 403/96, s. 48 (1).

(2) The insurer shall not terminate payment under subsection (1) unless the insurer provides the insured person with notice of the reasons for terminating payment. O. Reg. 403/96, s. 48 (2).

Right to Dispute

If an insurer refuses to pay a benefit under this Regulation or reduces the amount of a benefit that a person is receiving under this Regulation, the insurer shall provide the person with a written notice concerning the person’s right to dispute. O. Reg. 281/03, s. 23.

Mediation Proceedings

An insured person shall not commence a mediation proceeding under section 280 of the Act unless,

(a) the insured person notified the insurer of the circumstances giving rise to a claim for a benefit and submitted an application for the benefit within the times prescribed by this Regulation; and

(b) the insured person, if he or she was required to undergo a designated assessment under section 43, has undergone the designated assessment and has complied with that section. O. Reg. 546/05, s. 24.