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Baskaran v. Co-operators General Insurance Company (19-012169)

  • October 29, 2020

The claimant applied to the LAT disputing entitlement to IRBs and two medical benefits. The insurer had requested IEs to address the post-104 week IRB test, which the claimant refused to attend. The insurer argued that the claimant could not proceed with the dispute until attending IEs. The claimant argued that she had attended IEs addressing the pre-104 IRB test, and that the insurer was not permitted to assess for a benefit it was not paying. Adjudicator Grant agreed with the insurer and barred the claimant from proceeding with the dispute. He held that the insurer was not required to re-instate IRBs in order to assess post-104 week IRB entitlement. The claimant had submitted multiple reports addressing the post-104 week IRB test, while the insurer had none. Because of the change in statutory test, it was reasonable for the insurer to assess the claimant for entitlement, particularly given that she had obtained reports supporting the benefit. The prejudice to the insurer if it did not have its own assessments to address the IRB test was greater than the prejudice to the claimant of being required to attend. There was also a clear change in the claimant’s circumstances as her son had bene fatally stabbed after the insurer’s initial IRB IEs, and the claimant psychological functioning had worsened considerably.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, IE Non-Attendance
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