The plaintiff brought a motion for partial summary judgment seeking payment of two treatment plans under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The plaintiff argued the insurer failed to provide adequate medical and other reasons for denial under s. 38(8) of the Schedule, thereby entitling him to payment.
The insurer maintained that it consistently provided reasons for denials, including that the injuries fell within the Minor Injury Guidelines and that the insured failed to attend insurer examinations and provide requested medical documentation.
The court held that the evidence demonstrated ongoing communication and compliance by the insurer with statutory notice requirements.
Because the claims were intertwined with numerous other treatment plans and factual issues, partial summary judgment would not fairly resolve the dispute and a trial was required.