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P.M. v. Aviva General Insurance (18-009518)

  • August 17, 2020

The insurer was paying the claimant IRBs for over a year after the accident when it suspended IRBs due to the claimant’s failure to obtain necessary treatment and in providing relevant information under section 33 (the status of recommended psychological treatments and the updated clinical notes and records from the family physician). IRBs were reinstated after the claimant submitted a treatment plan for psychological treatment and remain ongoing. She applied to the LAT regarding the IRBs withheld for nine months. Adjudicator Makhamra concluded that the claimant was entitled to payment of the withheld IRBs. First, she held that while the claimant was in breach of section 33, the claimant had a reasonable explanation because she believed she was making best efforts and was complying with her family physician’s recommendations. She also believed the insurer had the ability to obtain the medical records with her consent. Second, the adjudicator held that the claimant was not in breach of section 57 as the claimant was receiving help for her psychological symptoms from her family physician and a social worker during the period of suspension.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Section 33, Section 57
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