The insurer argued that pursuant to s. 55 of the SABS the claimant was barred from proceeding with a claim for catastrophic impairment as he did not submit to an IE. The adjudicator concluded that the claimant was not barred. The insurer’s notices were argued to not provide medical and other reasons pursuant to section 44(5) of the Schedule. The notices had stated that the IEs were required, “to determine if the injuries you sustained in the accident resulted in impairments that would meet the catastrophic impairment definition.” The adjudicator found that the notices were non-compliant because they failed to refer to the claimant’s medical condition(s) and as a result it was unclear what the claimant’s medical conditions were. The adjudicator stated that the respondent insurer should have provided some context regarding what the conditions /impairments were. The adjudicator stated that at the very least the insurer’s reasons should include specific details about the claimant’s condition forming the basis for the claimant’s decision or alternatively identify information about the claimant’s condition that the insurer did not have but required.
