M.G. v. Aviva Insurance Canada (18-001568)

The claimant sought entitlement to four medical benefits, and argued that the insurer’s denials did not comply with section 38. Adjudicator Fricot concluded that the denial complied with section 38 because it explained the basis for the denial with reference to the claimant’s medical condition and the IE report. She also held that the insurer was not liable to pay for any expenses on the disputed treatment plans prior to the submission of the treatment plans. She ultimately awarded the cost of four pool sessions at a reduced rate and the cost of prescriptions.