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A.A. v. State Farm Mutual Automobile Insurance Company (16-000448)

  • March 9, 2017

The claimant sought entitlement to social rehabilitation counseling services. The insurer denied the claim asserting (i) the limitations period barred the claim and (ii) the claim was already adjudicated at FSCO under a different date of loss. Adjudicator Sewrattan cited section 23 of the Statutory Powers and Procedures Act in precluding a party from proceeding with a claim if it is to prevent an abuse of process. Adjudicator Sewrattan found that the claimant had litigated the disputed treatment plan at FSCO. As a result, the claimant’s LAT claim would amount to an abuse of process and was therefore barred. The insurer, citing that the matter was an abuse of process sought costs. However, Adjudicator Sewrattan cited access to justice reasons, as well as the fact that the claimant was self-represented and genuinely believed the matter could proceed, as reason not to award costs.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Costs
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