Insurer's request for an orthopaedic examination denied as not reasonably necessary given prior specialist assessments.
The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.
The insurer terminated income replacement benefits and, over four years later, requested that the applicant undergo a medical examination by an orthopaedic surgeon under section 42 of the Statutory Accident Benefits Schedule.
The applicant refused, arguing the examination was not reasonably necessary.
The arbitrator found that the insurer had already conducted multiple assessments by other specialists, including a neurosurgeon and an occupational medicine physician, none of whom recommended an orthopaedic evaluation.
The insurer failed to establish that the proposed examination was reasonably necessary or that its previous assessments were not meaningful evaluations of the applicant's physical condition.
The insurer's request was denied, and the applicant was awarded the expenses of the preliminary issue hearing.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesMay 17, 2002
