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K.R. v. Gore Mutual Insurance Company (17-005722)

  • March 4, 2018

This is a preliminary hearing decision on whether the insurer could complete s. 44 addendum reports in a hearing regarding CAT impairment determination. The claimant and the insurer had submitted medicolegal assessments on CAT determination. In addition, the claimant submitted addendum reports which affirmed her assessors’ original positions, following a review of the insurer’s reports. The insurer requested that its assessors complete addendum reports responding to the claimant’s addendum reports on the basis that the claimant’s addendum reports contained new opinion and comment. The insurer’s assessors declined to complete addendum reports without the claimant’s consent or an order from the LAT. The claimant did not consent to the addendum reports, which did not require her participation. The insurer brought a motion to the LAT to determine whether it had the right to have its assessors prepare addendum reports without the claimant’s consent. Vice Chair Flude dismissed the insurer’s motion on the basis that the claimant’s addendum reports did not contain any new opinion or comment. Vice Chair Flude rejected the insurer’s submission that new s. 44 notices of examination are not required in order for an insurer to complete s. 44 addendum reports/paper reviews, which do not require new physical examinations. Vice Chair Flude indicated that if the claimant’s addendum reports had raised new issues, procedural fairness would dictate that the insurer be permitted to have its experts prepare rebuttal reports.

Full decision here

TGP Analysis

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