The claimant sought entitlement to two treatment plans, including chiropractic services and physiotherapy. Adjudicator Mazerolle found that the claimant was not entitled to payment for either of the disputed treatment plans. The claimant alleged that the treatment plans were not denied within the ten-day timeline required by section 38(8) and that the insurer relied on an outdated insurer’s examination to deny the physiotherapy treatment plan, as this examination took place before the claimant was removed from the MIG. Adjudicator Mazerolle found that the insurer filed its denial letters within the ten-day window, which excluded statutory holidays. Further, although the insurer sent the denial letters to the claimant’s former legal representative, the claimant was copied and, therefore, it was considered to be proper service. With respect to the claimant’s argument that the insurer relied on an outdated examination, Adjudicator Mazerolle found that this submission was not properly understood as a challenge under section 38(8). Although the claimant might disagree with the insurer’s use of the medical report, the stated reliance is a medical reason in accordance with section 38(8)
