Category: IE Non-Attendance

N.H. v. Aviva Insurance Company (17-001088)

The claimant sought entitlement to medical benefits. The insurer, after receipt of the application to the LAT, arranged for an IE. The claimant objected and the Tribunal at a preliminary issue hearing determined that the IE was reasonable and could go forward. The Tribunal would adjourn the hearing on the merits to allow for the IE to be completed. The claimant sought reconsideration of this decision. However, Executive Chair Linda Lamoureux held that the Tribunal did not err. The Tribunal decision was affirmed and the claimant was afforded a further adjournment to attend the IE and then proceed to a hearing.

I.K. v. Primmum Insurance Company (16-001652)

The claimant sought entitlement to a number of medical benefits as well as attendant care benefits. The insurer argued the claimant was barred from proceeding with a LAT application for failing to attend a number of IEs, pursuant to section 55. The LAT agreed and dismissed the matter. On reconsideration, Executive Chair Linda Lamoureux upheld the decision. It was noted that IEs are an important tool for medical management. In this instance, the insurer’s requests were reasonable. The claimant raised an argument that section 55 should operate to bar a proceeding only for the benefits the IE is reviewing and allow all other claims to proceed. Executive Chair Lamoureux noted this argument was new and should have been raised at the Tribunal level and declined to exercise the discretion to hear fresh arguments at the reconsideration level.

M.K. v. Aviva Insurance Company (17-003608)

The claimant sought entitlement to NEBs, removal from the MIG, and one treatment plan. The insurer argued that the claimant failed to attend an IE. Adjudicator Watt agreed that the claimant failed to attend a scheduled IE, and he therefore could not dispute his entitlement to the denied treatment plan. In terms of NEBs, the adjudicator held that the claimant failed to submit sufficient evidence supporting his claim (the claimant had returned to work, and made very few complaints to his family doctor). The claimant’s injuries were found to fall within the MIG.

D.N. v. Aviva Insurance Company (17-004104)

The claimant sought entitlement to two assessments, and argued that the treatment plans were denied more than 10 days after submission. The insurer argued that the claimant failed to attend IEs. Adjudicator Norris agreed with the claimant that the treatment plans had been denied more than 10 days after submission due to the deeming provision at section 64(18) of the SABS relating to mail. However, the adjudicator also concluded that the insurer sent a proper denial before the proposed goods and services were completed, and they were therefore not payable. He also found that the claimant failed to attend a scheduled IE, and therefore could not dispute his entitlement to one of the proposed assessments. The other assessments was denied as being not reasonable and necessary.

Z.M. v. Aviva Insurance Company (17-002894)

The claimant sought removal from the MIG and three treatment plans. The insurer argued that the claimant failed to attend scheduled IEs. Adjudicator Norris concluded that the insurer’s IE notices complied with the SABS, and that the claimant failed to attend the IEs. He rejected the submission that the insurer had to provide the claimant with three different dates.

D.W. v. Heartland Farm Mutual (17-001508)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted the claimant was barred from proceeding to the LAT due to a failure to attend IEs scheduled. On review of the Notices provided, Adjudicator Rupinder Hans found the requested IEs to be reasonable. Accordingly, because the claimant failed to attend, the LAT application could not proceed

I.P. v. Aviva Canada Insurance (17-000465)

The insurer sought reconsideration of the underlying decision based on the adjudicator’s failure to make a determination on the applicability of section 37(7) (the provision allowing the insurer to not pay IRBs until the claimant attended an IE); the adjudicator had only made an order regarding section 55 (that the claimant had to attend the IE before she could pursue her claim at the LAT). Executive Chair Lamoureux held that the adjudicator erred in failing to address section 37(7). She held that the insurer was not required to pay the claimant IRBs until she attended the requested IE. The order was varied accordingly.

K.S.Y. v. Aviva Insurance Canada (16-003903)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to benefits proposed in two treatment plans for physical rehabilitation and one treatment plan for a psychological assessment. The insurer raised a preliminary issue, submitting that the claimant was precluded from adjudicating the issues in dispute for failure to attend s. 44 assessments. The claimant submitted that the notices of assessment did not comply with the requirements of s. 44 of the SABS. The preliminary issue hearing was held in writing. Adjudicator Makhamra held that the claimant could proceed with the application for the proposed physical treatment because after the claimant failed to attend the in-person assessment, the insurer proceeded with a s. 44 paper review. As the s. 44 paper review was completed and the claimant’s attendance was not required, Adjudicator Makhamra found there was no longer an issue of non-compliance with s. 44 in relation to the physical assessment. Adjudicator Makhamra found that the insurer’s notices of a psychological assessment were compliant with s. 44(5) of the SABS, and the medical and other reasons provided for the assessment met case law requirements. Adjudicator Makhamra held that the claimant was precluded from proceeding with the claim for a s. 25 psychological assessment as she failed to attend the s. 44 assessment.

M.B. v. Aviva Insurance Canada (16-002325)

The Tribunal initially held that the claimant failed to attend IEs related to post-104 week IRBs. The claimant applied for reconsideration and was successful. Executive Chair Lamoureux held that the IE notice sent to the claimant did not provide sufficient reasons, in particular because the insurer had simply restated its reasons from IEs related to initial entitlement to IRBs that “the impairments identified do not appear clearly or directly caused by the accident.” The Executive Chair reasoned that this notice would not have informed an unsophisticated person why a further IE was required for a benefit that had been granted and was being paid. The Executive Chair also held that the claimant need not raise the issue of the IE notice contents at the time of the IE, and that the issue could be raised for the first time during litigation.

M.B. v. Aviva Insurance Canada (16-002325)

The Tribunal initially held that the claimant failed to attend IEs related to post-104 week IRBs. The claimant applied for reconsideration and was successful. Executive Chair Lamoureux held that the IE notice sent to the claimant did not provide sufficient reasons, in particular because the insurer had simply restated its reasons from IEs related to initial entitlement to IRBs that “the impairments identified do not appear clearly or directly caused by the accident.” The Executive Chair reasoned that this notice would not have informed an unsophisticated person why a further IE was required for a benefit that had been granted and was being paid. The Executive Chair also held that the claimant need not raise the issue of the IE notice contents at the time of the IE, and that the issue could be raised for the first time during litigation.