Insurer not precluded from raising causation defence after initially approving attendant care benefits.
The applicant, injured in utero during a motor vehicle accident and born prematurely with cerebral palsy, sought attendant care benefits.
The insurer initially approved the benefits based on a medical report but later sought to raise a causation defence relying on a new report from an obstetrician.
The applicant argued the insurer was precluded from raising causation due to the two-year limitation period and waiver, and sought to exclude the new report.
The Adjudicator held that the insurer was not precluded from arguing causation, finding no waiver and that the limitation period in s. 56 of the Schedule applies to claims, not defences.
The Adjudicator also permitted the insurer to rely on the new medical report, finding it was validly obtained under s. 44.
OLATOntario Licence Appeal TribunalAug 26, 2020
