17-000363 v. Aviva General Insurance

Dec 18, 2017

Adjudicator: Blaine Baker

Issues:

1. Is the applicant entitled to $2,912.00 for the cost of an Orthopaedic Assessment performed by Dr. Wasserstein of Excel Medical Diagnostics that was submitted to the respondent on October 17, 2016 and denied on October 31, 2016?

2. Is the applicant entitled to interest on the overdue payment of benefits?

3. Is either party entitled to costs?

4. Is the applicant entitled to an award under s. 10 of Ontario Regulation 664, Automobile Insurance on the basis that the respondent unreasonably withheld or delayed payment?

Results:

1. The applicant is entitled to the cost of the assessment as it is deemed by the Tribunal to be reasonable and necessary. The respondent submitted the assessment was not reasonable or necessary because it was being prepared for a purpose other than the applicant’s diagnosis and treatment (a tort action). The Adjudicator found that the assessment was not related and the Applicant expressly denied it in the submissions.

2. The applicant is entitled to interest on the overdue payment of benefits.

3. Neither the applicant nor respondent is entitled to costs incurred in this application; and

5. The applicant is not entitled to an award under Regulation 644 as this argument was not properly substantiated.