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A.B. v. The Co-Operators Insurance Company (19-004401)

  • June 9, 2021

The claimant applied to the LAT seeking entitlement to benefits after being involved in an automobile accident in 2016. The insurer raised two preliminary issues: 1) Was the claimant statue-barred from proceeding with a claim for NEBs for failure to commence the application within the two year limitation period; and 2) Was the claimant entitled to medical benefits after non-compliance with s. 44 of the Schedule for failing to attend an IE assessment? Adjudicator Grant found that the claim was statute barred and the claimant was not entitled to dispute any of the 2017 treatment plans. He rejected the argument that the limitation period did not commence until IEs were received by the claimant, because there had been a denial upon submission of the treatment plans. Adjudicator Grant also found the that claimant was not entitled to NEBs due to non-compliance under s. 44. Adjudicator Grant was also asked to determine whether the claimant was entitled to 13 treatment plans, a special award and interest. In his decision, Adjudicator Grant highlighted that the onus is on the claimant to demonstrate that the disputed treatment plans are reasonable and necessary. In this case the claimant advanced medical evidence that was not consistent with the treatment being disputed. It was determined that the claimant failed to meet his burden, rendering the treatment plans not payable.

Full decision here

TGP Analysis

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  • FILED UNDER Limitation Period, IE Non-Attendance
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