The applicant was injured in a motor vehicle accident and sought statutory accident benefits for an orthopaedic mattress and retraining expenses.
The insurer denied the claims because the applicant incurred the expenses before submitting a treatment plan, contrary to section 38(1.1) of the Statutory Accident Benefits Schedule.
The applicant argued for relief from forfeiture under section 129 of the Insurance Act and section 31 of the Schedule.
The arbitrator held that the insurer was not liable to pay for the expenses because the treatment plans were not submitted prior to the expenses being incurred.
The arbitrator also found that section 129 of the Insurance Act and section 31 of the Schedule did not apply to relieve the applicant from the requirement to submit a treatment plan before incurring an expense.
The application was dismissed.
