Escobar v. The Guarantee Company of North America (20-000259)

The claimant sought entitlement to two treatment plans, including a medical benefit for dental treatment and a rehabilitation benefit for a hot tub. The claimant also sought a special award. Adjudicator Grant found that the claimant was entitled to the OCF-18 for dental treatment, but was not entitled to the OCF-18 for a hot tub, as the expense was incurred prior to the submission of the treatment plan, contrary to s. 38(2) of the Schedule. With respect to a special award, neither party made submissions. Adjudicator Grant therefore found that an award was not appropriate in the circumstances. It was not unreasonable for the insurer to rely on the reports of its assessors when denying the OCF-18 for dental treatment.