The claimant applied to the LAT disputing entitlement to four treatment plans. The insurer raised a preliminary issue that the disputed treatment plans were barred from litigation under section 55 of the SABS due to the claimant’s failure to attend section 44 IE assessments to address the disputed issues without a reasonable explanation. In response, the claimant alleged that one of the assessors did not show up for the scheduled IE to address one of the disputed plans. She further pleaded that the IEs were not reasonable or necessary as she had already attended a total of eight IEs since the onset of the claim. Lastly, that she withdrew her claim for one of the treatment plans, and argued that the non-attendance would not apply. Vice-Chair Farlam ruled that the claimant was barred from proceeding with her application due to non-compliance with section 44 of the SABS. She noted that, although the claimant had attended multiple IEs in the past, the insurer had approved the majority of similar treatments up to the time the IE notices were sent, and the insurer was entitled to a medical opinion to address the same. Furthermore, six of the IEs referenced occurred in 2016 and were not current opinions. The Vice Chair noted that by failing to attend a reasonable and necessary examination, the claimant had prejudiced the insurer. Finally, she also noted that, while the claimant alleged one of the assessors did not show up for the scheduled assessment, she had provided no evidence to support her claim; meanwhile the insurer provided letters rescheduling the assessment and notifying the claimant of the consequences of non-attendance.
