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D.S. v. The Personal Insurance Company (18-001204)

  • April 29, 2019

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a s. 25 psychology assessment. The insurer raised the preliminary issue of whether the claimant was statute barred from applying to the LAT for the psychology assessment because he failed to attend a s. 44 examination. The claimant was involved in an accident in 2014 and had previously attended a s. 44 psychology examination. In 2018, the claimant submitted an OCF-18 for a s. 25 psychology assessment. The insurer denied the treatment plan and arranged for a second s. 44 psychology assessment to address the claimant’s entitlement to benefits. The claimant did not respond to the s. 44 request and did not attend the s. 44 assessment. The claimant submitted that there was no non-compliance with the s. 44 notice as the notice was provided to the claimant only and not the claimant’s counsel. Adjudicator Ferguson found there was nothing in the SABS indicating that failing to provide a copy of a notice to a claimant’s representative provides a reasonable excuse for ignoring a notice. Adjudicator Ferguson agreed with the insurer that its request for another psychological assessment was reasonable considering the lengthy timeline between treatment requests and the lack of up-to-date medical records, and rejected as baseless the claimant’s submission that scheduling a s. 44 assessment reflects an insurer’s awareness that there is need of s. 25 assessments. Adjudicator Ferguson held that the claimant was statute barred from applying to the LAT for the psychological assessment, and that he was not entitled to treatment outside of the MIG. The application was dismissed.

Full decision here

TGP Analysis

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  • FILED UNDER Minor Injury Guideline, IE Non-Attendance
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