The preliminary issue in this matter is whether the claimant was barred from commencing a proceeding for certain medical benefits because she failed to comply with s. 44 of the Schedule by not attending an insurer’s examination. The claimant submitted an OCF-6 for cannabis prescription expenses and the insurer denied the expense pending a s. 44 examination to determine if the OCF-6 was reasonable and necessary. The claimant failed to attend the assessment and argued that it wasn’t a reasonable request, and the notice given wasn’t proper. Adjudicator Kepman agreed with the insurer that s. 44(3) of the Schedule allows insurers to determine benefits, including prescription medication, via a s. 44 examination. If the legislature intended to exclude prescription drugs, they would have included language to make this clear. Further, Adjudicator Kepman found that the insurer’s reasons for the examination were proper, namely to determine if the OCF-6 was reasonable and necessary due to a lack of medical documentation. Finally, Adjudicator Kepman found that the assessment was reasonable as the claimant had failed to provide the requested information under s. 33 and therefore a s. 44 assessment was required. Adjudicator Kepman concluded that the claimant was barred from commencing a proceeding as a result of s. 44.
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