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Spiegel v. Intact Insurance Company (20-000279 & 20-000408)

  • July 19, 2021

Intact requested a preliminary issue hearing as the claimant failed to attend insurer examinations. Intact requested that two issues for medical benefits be barred from dispute pursuant to section 55. The claimant was involved in two accidents which were joined into a single matter for the purpose of the preliminary issues hearing. The two disputed treatment plans were for medical cannabis, which the claimant said was required for low back pain, and a second treatment plan for a stress therapy reduction system and shiatsu massage chair, which the claimant said would reduce the need for pain medication and increase stamina, motivation and social and recreational activities. The claimant stated that he did not attend the assessments because: the IE assessors did not have an expertise in cannabis therapy; the claimant was only able to attend an assessment on a Saturday or Sunday at 2:00 PM; the claimant demanded to record his assessment; the claimant demanded to bring his own chaperone into the assessment with him, and the claimant demanded that he would be able to conduct his own section 25 assessment in response to the section 44 assessment. The claimant requested that an Order enforcing the conditions of his attendance at the IEs. Vice-Chair Johal ruled in Intact’s favour, noting that specific medical and other reasons for the denials and IEs were given in accordance with M.B. v. Aviva, and that Intact contacted the claimant and offered alternative accommodations and attempted to reschedule the assessments. Vice-Chair Johal noted that, as in J.C. v. Aviva, as long as there was sufficient medical and other reasons and the IE was reasonable and necessary, the claimant would be required to attend. The assessments proposed by Intact were considered reasonable and necessary and the claimant was barred from disputing the medical benefits until he attended the IEs. Vice-Chair Johal further noted that it was not within the Tribunal’s power to Order the insurer to allow the claimant to video record his IEs.

Full decision here

TGP Analysis

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  • FILED UNDER IE Non-Attendance
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