K.K. v. Coseco Insurance (18-002839)

The claimant disputed his MIG determination and entitlement to various medical benefits. The respondent raised a preliminary issue, arguing that the claimant was statute-barred from proceeding with his claim in respect of two of the disputed treatment plans for failure to dispute entitlement within the two year limitation period. Adjudicator Norris agreed, noting that the insurer’s denial letters were clear and unequivocal denials of the benefits and included notice of the two year limitation period, information on the claimant’s right to dispute, and medical and other reasons for the denial. Adjudicator Norris further concluded that the claimant had not met his onus of establishing that his injuries fell outside of the MIG, and was thus bound by the $3,500 funding limit.