Insurer's appeal dismissed; boilerplate reasons for denying SABS treatment plans are legally inadequate.
The appellant insurer appealed a License Appeal Tribunal reconsideration decision that found the insurer provided inadequate reasons for denying the respondent's treatment plans and requesting an insurer's examination under the Statutory Accident Benefits Schedule.
The Divisional Court dismissed the appeal, holding that the Executive Chair reasonably concluded the original adjudicator erred in law by accepting boilerplate reasons.
The court affirmed that an insurer must provide meaningful reasons to permit an insured to decide whether to challenge a denial.
ODCDivisional CourtSep 23, 2019
