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N.M. v. Aviva Insurance Canada (18-008710)

  • January 19, 2021

The claimant was involved in two accidents. He sought entitlement to NEBs for the second accident, and sought various medical benefits for both accidents. Adjudicator Paluch held that the claimant was entitled to NEBs up to the two-year mark because the insurer failed to properly stop entitlement. The insurer had stopped payment of NEBs after receiving paper review IEs, but the claimant had never received a notice under section 44 indicating that the paper review was taking place. Adjudicator Paluch found the insurer’s breach of sections 36 and 37 resulted in the claimant’s continuing entitlement to NEBs. The claimant was also awarded two treatment plans for physiotherapy for the second accident. Two claimed assessments were dismissed because they were completed before ten business days had elapsed after submission of the treatment plans, contrary to section 38(2).

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Non-Earner Benefits
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