The Tribunal determined that the Applicant remains subject to the minor injury. Vice-Chair Maich agreed with the preliminary issue submissions that the Applicant was not in compliance with his obligations under section 44(9) of the Schedule and that section 55(1) applied. As such, the Applicant was barred from proceeding with several of the disputed treatment plans. Definity was determined to be not liable for any expenses incurred pursuant to the remaining treatment plans in dispute.
The Tribunal found the preliminary issue submissions to be persuasive in regards to the Applicant’s failure to attend a neurological insurer’s examination requested under section 44 of the SABS. The Tribunal determined that the notices of examination were valid and sufficient pursuant to s.44(5) of the SABS, that the neurological assessment was reasonably necessary pursuant to s. 44(1) of the SABS, and that the Applicant did not provide any reasonable explanation for his non-attendance. The Tribunal noted that the Respondent later made repeated efforts (6 subsequent occasions) to have the examination rescheduled, without any response from the Applicant. The Tribunal ultimately found that the Applicant could not proceed with the issues in dispute outlined in the decision at paragraphs [6]3,5,6,7,and 8. The Tribunal declined to exercise its discretion under s.55(2) of the SABS as the circumstances did not give rise to an established reason to proceed with the Application.
On the substantive issues, the Tribunal also found that the Applicant remained within the MIG. The Vice-Chair stated that the Applicant did not meet his onus for removal from the MIG. The Tribunal emphasized that it could not create arguments on a party’s behalf and therefore found that the Applicant had not met his burden to establish that he should be removed from the MIG. The decision also notes that much of the Applicant’s written material focused on complaints about his former legal representation, allegations about an improper relationship between his treatment clinic and legal counsel, and concerns about the insurer’s assessors. The Tribunal held that those issues were outside its jurisdiction and the Tribunal could not render decisions on issues that are not within its jurisdiction.
The Tribunal then considered the two remaining treatment plans that were not barred on the preliminary issue. The Tribunal confirmed that, to recover payment for a treatment plan, the Applicant had to prove that the treatment was reasonable and necessary as a result of the accident. The Tribunal stated that the Applicant made no submissions in regards to these treatment plans and could not construct submissions on behalf of any party. The Tribunal stated that it is compelled to find that the Applicant has not met this onus and is not entitled to the treatment plans outlined in paragraphs [6]2 and [6]4 of the decision.
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