M.Z. v. Aviva Insurance Canada (18-001324)

The claimant sought entitlement to the balance of a chiropractic treatment plan, four other treatment plans, and an award. The claimant argued the balance of the chiropractic treatment plan should be approved because the insurer failed to provide a response within 10 business days pursuant to section 38(3) of the Schedule. The insurer argued that the limitation period applied to one of the treatment plans. Adjudicator Grant found that the insured mailed the denial letter to the claimant, and it was deemed to have been received by the claimant on the fifth business day after it was mailed under section 64(18). Based on that date, the claimant’s LAT application was filed after the two-year limitation period, making the chiropractic treatment plan not payable. The other treatment plans were also found not payable based on a lack of objective supporting evidence.