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G.A.E. v. Aviva Insurance Canada (17-000317)

  • February 16, 2018

The claimant sought entitlement to a number of medical benefits. In addition to a MIG position, the insurer asserted that the claimant was barred from bringing a claim as notice to claim accident benefits was not provided within seven days (or reasonably thereafter) of the MVA, pursuant to sections 32 and 55. Adjudicator S.F. Mather reviewed the circumstances leading up to the claimant providing an application for accident benefits and determined that the claimant gave adequate notice to the insurer “as soon as practicable in the circumstance.” The claims were heard on the merits, and Adjudicator Mather determined that the Notice letters of the insurer were insufficient on several grounds. Accordingly, the insurer was barred from taking a MIG position. Each treatment plan was reviewed on the merits and half, mostly dealing with physical therapy, were considered reasonable and necessary. Those treatment plans were found payable, while the remaining claims were dismissed as either being not reasonable or a duplication.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Late Application
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