Category: IE Non-Attendance

This preliminary issue hearing was brought to determine whether the claimant was statute barred from proceeding with his claim for attendant care benefits on the ground that he failed to attend an Otolaryngologist IE requested under section 44 of the SABS. Adjudicator Chakravarti found that the insurer failed to provide “medical and other reasons” for the assessment, and thus did not provide the claimant with valid notice of the assessment. The adjudicator indicated that the reasons were boilerplate, and did not provide any connection between the requested Otolaryngologist assessment and the attendant care benefit. As such, the claimant was not in non-compliance with the SABS and was entitled to proceed with his claim.

The claimant was injured in an accident on February 2, 2017 and disputed his MIG status. The insurer argued that the claimant had failed to attend several IEs and was barred from proceeding to the LAT . Adjudicator Norris ruled in favour of the claimant as the insurer had failed to provide adequate medical or other reasons, and had failed to provide direct notice that one of the disputed plans was being addressed at the assessment.

The claimant sought various accident benefits, including post-104 IRBs. The insurer denied benefits based upon its MIG position. During the course of the claim, the insurer scheduled numerous IEs to determine the MIG and various benefits in dispute, which the claimant did not attend. Following the case conference, with agreement from claimant’s counsel, the insurer rescheduled two of the IEs; the claimant again did not attend. The claimant alleged he had been evicted from his home. At the time of the preliminary issue hearing, the claimant had failed to attend a total of 9 IEs. Adjudicator Boyce ruled that the claimant could proceed with the disputes regarding the MIG, the cost of a chronic pain assessment OCF-18 and the cost of chiropractic treatments as he attended the related IEs. He was barred from proceeding from the remainder of the claim, including IRBs due to failure to attend the relevant IEs.

The insurer brought a preliminary issue hearing on the grounds that the claimant was barred from proceeding with her application for catastrophic determination and post-104 IRBs for failure to attend section 44 IEs. Adjudicator Boyce agreed with the insurer, and found that the claimant was barred from proceeding with her application. The insurer had a right to a full answer and defence where a claim for catastrophic impairment had been made, and was entitled to be on equal evidentiary footing with the claimant. The claimant’s non-attendance at properly scheduled section 44 IEs frustrated the insurer’s right.

The insurer brought a preliminary issue hearing on the grounds that the claimant was barred from commencing a proceeding for failure to attend NEB IEs. The insurer made several attempts to schedule NEB IEs, in response to which the claimant asked for the IEs to be rescheduled. The IEs were ultimately scheduled to take place shortly after the LAT case conference, and the claimant failed to attend. The claimant took the position that it was unreasonable to conduct IEs so closely after a case conference and she should be exempt from attending the IE. Adjudicator Norris disagreed, noting that there was no legislative or precedential basis for the claimant’s position. As such, the adjudicator found that the claimant was barred from disputing her entitlement to NEBs, but could proceed with her claim for entitlement to medical benefits.

The claimant applied to the LAT seeking entitlement to chiropractic treatment, a psychological assessment, and an orthopaedic assessment. The insurer raised the preliminary issue of whether the claimant was barred from proceeding with her claim for the psychological assessment as she failed to submit to an insurer’s examination. Adjudicator Maleki-Yazdi found, pursuant to s. 55 of the SABS, that the claimant was barred from applying to the LAT for all of the benefits in dispute for failure to attend the IE psychology assessment, until such time as the claimant attended the assessment.

The insurer sought a determination that the claimant was barred from proceeding to the LAT on the basis that he failed to attend insurer’s CAT assessments. The claimant took the position that he was not required to attend the assessments as the insurer failed to set out the medical and other reasons for requiring the assessments, as required by s. 45(3) and 44(5) of the SABS. Adjudicator Gosio found that the insurer did not adequately explain its position with reference to the claimant’s medical condition, and that the claimant was not barred from proceeding with his application to the LAT.

The claimant sought entitlement to IRBs; the insurer argued that section 55 barred the dispute because the claimant failed to attend IEs. Adjudicator Punyarthi held that the insurer, rather than the claimant, failed to comply with section 44 by failing to make the IEs on a date, time, and location that was convenient to the claimant. Further, the claimant’s requests to reschedule the IEs were not responded to by the insurer. The IRB dispute was permitted to proceed.