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A.K. v. Aviva Insurance Canada (16-004622)

  • February 27, 2018

The claimant sought entitlement to three disputed treatment plans and the payment of an OCF-3. Adjudicator Anwar found that the claimant was entitled to all three disputed treatment plans but not the cost of the OCF-3. Adjudicator Anwar concluded that the accident aggravated the claimant’s pre-existing chronic back and neck pain and the proposed treatment plans were reasonable and necessary. Adjudicator Anwar held that the 27 minute surveillance video was not sufficient to sway him that the claimant did not have functional limitations and did not suffer from chronic pain. Adjudicator Anwar opined that as the insurer did not provide the surveillance report to its assessors or rely on the report to deny the treatment plans, he did not attach any weight to the surveillance. As for the OCF-3, Adjudicator Anwar concluded that as the insurer did not request the updated OCF-3 and as the OCF-3 did not provide any new information, the insurer was not liable to pay for this expense.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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