Insurer permitted to conduct medical examination where DAC failed to assess reasonableness of treatment plans.
The insurer brought a motion for an order permitting its medical expert to conduct an examination of the insured pursuant to section 42 of the Statutory Accident Benefits Schedule.
The insured, an 83-year-old man who suffered a catastrophic impairment in a motor vehicle accident, sought funding for home modifications to return home from a nursing home.
The medical/rehabilitation Designated Assessment Centre had failed to address the reasonableness and necessity of the treatment plans, instead improperly revisiting causation.
The arbitrator found that, given the DAC's failure to assess the treatment plans and the lack of a recent physical examination, the insurer's request for an examination was reasonable and necessary.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesApr 17, 2003
