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N.C. v. Aviva General Insurance Company (19-004666)

  • January 6, 2021

The claimant sought reconsideration of the Tribunal’s decision dismissing entitlement to medical benefits. Adjudicator McGee noted that the claimant filed her reconsideration submissions nearly a month after the deadline for submissions. Vice Chair McGee did not make any findings on procedural issues for the late findings, as she dismissed the reconsideration application on its merits. With regard to the claimed medical benefits, Vice Chair McGee held that the Tribunal applied the proper “”reasonable and necessary”” test in concluding that the claimant had reached maximum medical recovery and that no further facility based treatment was warranted. Vice Chair McGee also rejected the claimant’s arguments regarding the claimed MRI being available through OHIP. She reiterated that pursuant to section 47(2), the insurer was not required to pay for the MRI because it was reasonable available through OHIP.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, LAT Rules, Reconsideration
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