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V.D. v. Aviva Insurance Canada (18-007435)

  • April 30, 2019

This is a preliminary issue decision addressing the following issues: 1) whether the claimant was statute barred from applying to the LAT for non-earner benefits for failure to attend a s. 44 OT assessment, and 2) whether the claimant was barred from proceeding with her claim for payment of a psychological assessment. Adjudicator Ferguson held that the claimant was not barred from applying to the LAT pursuant to s. 55 because the insured’s notice of assessment did not provide adequate medical and other reasons for requesting the OT assessment. Adjudicator Ferguson held that the LAT had no jurisdiction over the cost of examination claimed by the claimant as there was no dispute over the claimant’s entitlement or the amount payable. The only issue was that the insurer required a detailed breakdown of costs from the treatment provider prior to paying the incurred benefit. Adjudicator Ferguson held that the claimant could not proceed with her claim for the cost of the psychological assessment.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, IE Non-Attendance
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