Appeal for medical benefits allowed; limitation period reset by insurer's equivocal reconsideration and second denial notice.
The applicant was struck by a taxi as a pedestrian, sustaining severe facial injuries.
She sought statutory accident benefits for septorhinoplasty and scar revision, which the insurer denied.
The insurer raised a preliminary issue that the appeal was statute-barred under s. 56 of the Statutory Accident Benefits Schedule.
The Tribunal found the appeal was not statute-barred because the insurer's subsequent reconsideration and second denial notice rendered the initial denial equivocal, resetting the limitation period.
On the substantive issues, the Tribunal found the proposed treatments were reasonable and necessary, preferring the evidence of the applicant's plastic surgeon over the insurer's expert.
The appeal was allowed and the disputed benefits were ordered payable with interest.
OLATOntario Licence Appeal TribunalJul 29, 2019
