The applicant sought statutory accident benefits for a physiotherapy treatment plan following a motor vehicle accident. The respondent insurer denied the plan and required the applicant to attend insurer examinations. The Tribunal found that the respondent's notices denying the plan and requiring the examinations did not comply with the requirements of sections 38(8) and 44(5) of the Schedule, as they failed to provide meaningful medical and other reasons. Consequently, the applicant was not required to attend the examinations, and the treatment plan became payable under section 38(11)2 upon proof that the expenses were incurred. The Tribunal also awarded interest and a 10 percent award under section 10 of O. Reg. 664, finding the respondent's prolonged failure to provide meaningful reasons to be stubborn and unyielding.
Citation: Miele v. TD Insurance Meloche Monnex, 2023 ONLAT 21-012994/AABS
Licence Appeal Tribunal File Number: 21-012994/AABS
In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.
Between:
Nicola Miele
Applicant
And
TD Insurance Meloche Monnex