S.L. v. Aviva Insurance Company of Canada (17-004989)

The claimant sought entitlement to three treatment plans, costs of various examinations, and interest on overdue payments. The insurer denied the first two treatment plans as the claimant had not exhausted MIG limits, but had later removed the claimant from the MIG. The insurer denied the third plan for not being reasonable and necessary, as well as a proposed orthopaedic assessment. Adjudicator Norris determined that the claimant was entitled to partial payment of the third treatment plan, and the costs of an orthopaedic assessment, as they were reasonable and necessary based on the records from the family physician.  He also granted the claimant interest on any overdue payments from the insurer. However, Adjudicator Norris upheld the denial of the first two treatment plans pursuant to section 38(5) of the SABS.