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Smith v. Intact Insurance, (21-005342/AABS – PI)

  • January 9, 2023

The claimant submitted an application for determination of catastrophic impairment. The insurer scheduled two IEs (psychological and occupational therapy), which the claimant attended. However, Dr. Kiss (psychologist) passed away before he could complete his report, and the insurer determined that the claimant had not meaningfully participated in the situational portion of the OT IE. The insurer issued a second set of notices of examination, which the claimant refused to attend. Vice Chair Logan held that the claimant was non-compliant with s. 44 with respect to the subsequent OT IE situational assessment and stayed the claimant’s application until he complied with the notice of examination. As the claimant was seeking a CAT determination under Criterion 8, Vice Chair Logan held that there was a reasonable nexus between the situational assessment and the claimed impairment, and the insurer would be prejudiced if the situational assessment was not completed. Vice Chair logan held that a second in-person psychology IE was not reasonably necessary, and that a paper review of Dr. Kiss’ assessment and file material would be sufficient. The claimant had already attended one psychology IE, and would be significantly prejudiced if he was required to undertake a new in-person IE, more than 2 years after the initial IE.

Full decision here

TGP Analysis

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