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E.B. v. Aviva Insurance Canada (18-010159)

  • June 5, 2019

The claimant sought entitlement to acupuncture, massage, and chiropractic therapy, a social work assessment, an in-home assessment, the cost for the production of a disability certificate, and interest on the overdue payment of benefits. Adjudicator Norris did not find the disputed treatment, assessments, and cost for the production of a disability certificate to be reasonable or necessary for the following reasons: the claimant was reported to be virtually pain-free and functional at the time the chiropractic and physiotherapy treatment plan was proposed; there was no evidence of the claimant experiencing the social problems that the social work assessment aimed to address; there was no evidence showing the claimant required an in-home assessment due to being disabled from completing his personal care tasks; and the insurer did not request the production of the disability certificate. As such, no interest was payable to the claimant since no benefits were owed to him.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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