The insurer sought reconsideration of the Tribunal’s award of an orthopaedic assessment. Vice Chair Mather granted the reconsideration and denied the claimed assessment. She held that the Tribunal made a significant error of law in concluding that section 38(8) required a “clear and unequivocal” denial of the goods and services it was not agreeing to pay for. She held that the denial satisfied the requirements of section 38(8), and that the claimant failed to attend an IE. Vice Chair Mathers reviewed the submissions of the parties and held that the claimant failed to prove that the orthopaedic assessment was reasonable and necessary. She noted that the claimant had refused a similar referral from his family physician, and his medical imaging did not show any abnormalities. Further, the clinical notes and records did not support the existence of any orthopaedic injury.
