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Gibson v. Intact Insurance Company (20-012060)

  • February 8, 2023

The claimant applied to the LAT for the approval of multiple treatment plans, including a treatment plan for a tractor. The insurer brought a motion to bar the claimant from disputing the entitlement to the tractor for failing to attend s. 44 IEs. The LAT added the claimant’s non-attendance at the IEs as a preliminary issue. The claimant attended the first three of the five IEs scheduled by the insurer but, despite having received notices of examination, failed to appear to the final two IEs. The claimant submitted that the additional two IEs were duplicative and unnecessary, that the delay between the first three IEs and the final two IEs was questionable, and alleged that the insurer scheduled the final two IEs as a means of “expert shopping”. The insurer contended that the two scheduled IEs qualified as reasonably necessary, the nexus between the IEs and the claimant’s injuries was made out, and that the claimant had not yet undergone neurology and orthopaedic assessments. Adjudicator Pahuta found that that there was a nexus between the claimant’s physical impairments and the two IEs and that the conclusions of the previous IEs favoured the scheduling of the two IEs. Adjudicator Pahuta further stated that the claimant’s own assessments did not negate the need for the insurer’s two IEs and that there was nothing questionable about the timing of the IEs. Adjudicator Pahuta held that the insurer’s two proposed IEs were reasonably necessary, and the claimant’s failure to attend was fatal to his ability to proceed with the dispute concerning the treatment plan for the tractor.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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