Insurer ordered to pay for medical assessment but not duplicative FAE; no expenses awarded due to representative's misconduct.
The applicant was injured in a motor vehicle accident and sought payment from her insurer for a multidisciplinary assessment, including a medical assessment and a Functional Abilities Evaluation (FAE), after the insurer denied further treatment based on a prior Designated Assessment Centre (DAC) report.
The arbitrator found that the medical assessment was a reasonable expense as it provided necessary treatment recommendations that the DAC report lacked.
However, the FAE was deemed unreasonable as it duplicated a recent assessment without justification.
The arbitrator dismissed the applicant's claim for a special award, finding the insurer's conduct did not amount to unreasonably withholding benefits.
Due to the applicant's representative's unfounded allegations of bias and obstructive conduct, no expenses were awarded to the applicant despite her partial success.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesApr 10, 2001
