The sole issue in dispute was whether the claimant was entitled to a special award under Ontario Regulation 664. All of the substantive issues, including a claim for income replacement benefits, physiotherapy, and several assessments were resolved in advance of the hearing. Adjudicator Boyce agreed with the claimant on two grounds: (1) denying section 25 assessments on the basis that they are “duplications of service” because section 44 IEs have recently been completed is not a valid medical reason for a denial; and (2) insurers have an obligation to reconsider its earlier benefit denials once a claimant is removed from the MIG. As such, Adjudicator Boyce found that a nominal award totalling $400 was appropriate (representing a bit less than 5% of the total benefits claimed), in order to remind the insurer of its continuing duty to adjust the file in good faith and provide valid reasons when denying a claim.
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