The applicant sought reconsideration of a Licence Appeal Tribunal decision which found that the insurer, Aviva, provided adequate reasons for denying two treatment plans and requesting an insurer's examination.
The Executive Chair granted the reconsideration, finding that Aviva's stated reason—that it was unable to determine if the recommendations were reasonably required and that the treatment did not appear consistent with the diagnosis—was inadequate under s. 38(8) of the Statutory Accident Benefits Schedule.
The insurer failed to provide meaningful details based on the applicant's medical file.
Consequently, the Tribunal's previous order was cancelled and the mandatory consequences under s. 38(11)2 applied.
