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Applicant v. Aviva Insurance Canada (17-006138)

  • August 21, 2018

The claimant sought entitlement to two treatment plans for chiropractic and psychological services. Adjudicator Watt found that the claimant was not entitled to the benefits in dispute. Adjudicator Watt found that many of the medical complaints raised by the claimant were not connected to the 2013 motor vehicle accident. Adjudicator Watt found that the treatment plans were not reasonable and necessary as a result of the accident. The claimant’s MIG status was not listed as an issue in dispute, but Adjudicator Watt also found that there was no evidence before the Tribunal that would take the claimant outside of the MIG. Adjudicator Watt found that the self-represented claimant had circumvented the disclosure process by returning consents for third party information late, which unfairly prevented the respondent from obtaining a decoded OHIP summary. The respondent sought a costs award. Adjudicator Watt noted that the previous adjudicator in the dispute resolution process found that the self-represented claimant had acted disrespectfully and unprofessionally, but he held that this behaviour did not meet the high standard required for an order for costs.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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