ABR Updater: The “Medical and Other Reasons” Required to Justify an Insurer Examination

The purpose of this article is to provide a brief “refresher” on the scope of the “medical and other reasons” that must be provided by an insurer to its insured when an insurer examination (“IE”) is being requested.

Save for the exceptionally lucky, most people who have been injured as a result of a motor vehicle accident and who have claimed accident benefits from an insurance company have at some point received a letter from the insurer requesting that they attend an IE. The letter usually reads along the lines of:

We are in receipt of the Assessment and Treatment Plan (OCF-18) dated May 1, 2017, authored by John Doe for physiotherapy treatment in the amount of $1,800.00.

We are unable to approve this plan as we have insufficient medical information in the file to support the need for ongoing physical treatment. Please be advised that we are referring you for an insurer examination in accordance with section 44 of the Statutory Accident Benefits Schedule.

A Notice of Examination is attached.

When an insurer wishes to send its insured to an IE there are certain notice requirements that must be satisfied. Those requirements are set out in section 44(5) of the Statutory Accident Benefits Schedule.

Read full article: Accident Benefit Reporter Updater, Issue 37

If you have any questions, please contact personal injury lawyer Deanna Gilbert at 416-868-3205 or by EMAIL.

Other articles by Deanna Gilbert:

https://trlaw.com/news/cpp-not-a-policy-of-insurance-per-opcf-44r/