A.U. v. TD Insurance Meloche Monnex (19-000276)

The claimant sought entitlement to the cost of a chronic pain assessment. The insurer argued that the claimant failed to attend an IE and was barred from disputing entitlement. The claimant argued that the denial was not sufficient under section 44, as there was no reference to medical records or having reviewed the treating practitioner’s opinion. Adjudicator Grant decided in favour of the insurer, noting that there is no specific requirement under section 44 that requires a direct reference to medical records or a review of the treating practitioners’ opinion on the matter. He also wrote that the claimant had in fact moved to Singapore, and that it would be difficult for the insurer to ascertain whether or not the treatment was reasonable and necessary without a medical opinion given the lack of activity on claim and lack of treatments for such an extended period of time.