Adam J. Ezer

The applicant sought payment for a family and social assessment and custom orthotics following a motor vehicle accident.

The applicant argued that the insurer failed to respond to the treatment plans within the required time, resulting in deemed approval under the Statutory Accident Benefits Schedule.

The arbitrator held that the deemed approval provisions relate to the timing of interim payments pending dispute resolution and do not override the substantive requirement that expenses be reasonable and necessary.

The arbitrator found insufficient evidence to prove the treatment plans were properly submitted or that the claimed expenses were reasonable and necessary.

The claims were dismissed.

The insurer brought a motion to add the Motor Vehicle Accident Claims Fund (MVAC) as a co-respondent or third party to an arbitration proceeding, arguing MVAC was responsible for any special award arising from its prior handling of the file.

The arbitrator dismissed the motion, finding no statutory jurisdiction under the Insurance Act to add an insurer to a proceeding over the applicant's objection.

The arbitrator also dismissed the insurer's motion to strike the applicant's claim for a special award, instead amending the issue to reflect the insurer's potential liability for both its own actions and those of MVAC.

The insurer was ordered to pay the legal expenses of both MVAC and the applicant.