The sole issue in dispute was whether the claimant was entitled to a special award under Ontario Regulation 664. The insurer initially denied a treatment plan, and referred the claimant to an IE to determine whether the plan was reasonable and necessary. Upon receipt of the IE reports, the insurer wrote to the claimant confirming that the IE assessor concluded that the treatment plan was not reasonable and necessary, but advised that it was nevertheless approving the treatment plan in full, as the IE report was not provided to the claimant within 10 days as required under the SABS. The claimant argued that the insurer’s communications to the claimant were unclear, and led to an unreasonable delay in the availability of benefits. Adjudicator Farlam declined to order a special award, as there was nothing ambiguous, unclear, or confusing in the insurer’s communications, and no reasonable basis to misinterpret the communications as a denial of the proposed treatment plan.
