Defective denial notices compel insurer to pay for assessments despite applicant remaining in Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer denied treatment plans for neurological and chronic pain assessments, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant filed her appeal beyond the two-year limitation period, but the Tribunal granted an extension under s. 7 of the LAT Act.
While the Tribunal found the applicant's injuries did not warrant removal from the MIG, it held that the insurer's denial notices failed to provide sufficient medical reasons as required by s. 38(8) of the Schedule.
Consequently, under s. 38(11), the insurer was ordered to pay for the disputed assessments with interest.
OLATOntario Licence Appeal TribunalJul 18, 2024