Da Silva v. Wawanesa Mutual Insurance Company, 2023 CanLII 1450

Case Summary

The applicant sought statutory accident benefits following a motor vehicle accident. The respondent insurer raised a preliminary issue that the applicant was barred from proceeding with her claim for income replacement benefits (IRBs) and one occupational therapy treatment plan because she failed to attend scheduled insurer's examinations (IEs). The Tribunal found that the insurer provided valid notices of examination with sufficient medical reasons, and that the IEs were reasonably necessary to assess the post-104-week IRB test. Consequently, the applicant was barred from proceeding with those claims under s. 55(1)2 of the Schedule. However, the Tribunal found the applicant was entitled to two other occupational therapy treatment plans because the insurer's denial notices failed to provide clear and specific medical reasons as required by s. 38(8) of the Schedule. The applicant's request for a special award under Regulation 664 was dismissed.