Category: Section 33

S.U. v. Wawanesa Mutual Insurance Company (16-003333)

The claimant sought entitlement to medical benefits; the insurer argued that the claimant had not complied with section 33 requests and that the claimed benefits were not reasonable and necessary. Regarding the section 33 argument, Adjudicator Ferguson held that the information requested by the insurer was not “reasonably necessary” to determine entitlement as the insurer had already rejected the claims prior to making the section 33 requests. Regarding the medical benefits claimed, Adjudicator Ferguson held that the medical evidence did not support that the treatment was reasonable or necessary.

W.P. v. Aviva Insurance (16-000693)

In this preliminary issue decision, the insurer argued that the claimant had failed to attend an IE and EUO and therefore could not proceed to arbitration at the LAT. Adjudicator Neilsen held that the insurer’s request for an IE was reasonable, and the insurer had provided a notice that satisfied section 38 of the SABS. The claimant was barred from seeking the claim, but was given 30 days to rectify the non-attendance. Adjudicator Neilsen left the issue of EUO non-attendance to the hearing adjudicator.