The claimant applied to the LAT disputing entitlement to IRBs and a medical benefit. The insurer brought a preliminary motion arguing that the claimant was barred from proceeding with the dispute as he applied to the LAT more than two years after the denials. Adjudicator Boyce agreed with the insurer and dismissed the claimant’s medical benefits dispute. With respect to IRBs, the claimant had argued that the insurer’s denial letter did not comply with section 37 as it did not include medical and other reasons. Adjudicator Boyce disagreed and noted that when an insured returns to work, an insurer was not required to fabricate a medical reason for stopping an IRB, as the medical reason is the return to work. With respect to the disputed medical benefit, Adjudicator Boyce found the insurer’s denial letter to be clear and it provided medical reasons, being that the claimant was discharged from treatment. The insurer also argued that the claimant was barred from applying to the LAT disputing IRBs pursuant to s. 55. Adjudicator Boyce noted that the insurer’s s. 44 notices complied with the SABS and there was correspondence indicating that the claimant was fully aware of the IEs but chose not to attend. Adjudicator Boyce dismissed the claimant’s IRB claim based on s. 55 as well.
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