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Insurer cannot rely on limitation period where partial settlement did not permanently end benefit entitlement.
The applicant, who was catastrophically impaired in a 2013 motor vehicle accident, sought payment for an in-home occupational therapy assessment to determine ongoing attendant care and housekeeping needs.
The respondent insurer denied the claim, arguing it was statute-barred under s. 56 of the Schedule because a previous denial was not disputed within two years, and that the assessment was not reasonable and necessary.
The Tribunal found that a 2016 partial settlement agreement did not permanently end the applicant's entitlement to these benefits and no settlement disclosure notice was provided.
The Tribunal concluded the claim was not statute-barred and that the assessment was reasonable and necessary given evidence of changes in the applicant's circumstances.
