Applicant v. Aviva General Insurance Company (19-002413)

This preliminary issue hearing was brought to determine whether the claimant was statute barred from proceeding with his claim for attendant care benefits on the ground that he failed to attend an Otolaryngologist IE requested under section 44 of the SABS. Adjudicator Chakravarti found that the insurer failed to provide “medical and other reasons” for the assessment, and thus did not provide the claimant with valid notice of the assessment. The adjudicator indicated that the reasons were boilerplate, and did not provide any connection between the requested Otolaryngologist assessment and the attendant care benefit. As such, the claimant was not in non-compliance with the SABS and was entitled to proceed with his claim.