Morelli and State Farm [+] Appeal, 2014-03-21, Reg 403/96. Final Decision FSCO 4142.

https://www5.fsco.gov.on.ca/AD/4142

(2) Consequently, State Farm had Ms. Morelli seen at an insurer’s medical examination (“IME”) by three medical examiners, Dr. D. Young, psychologist, Dr. B. Clark, physiatrist and Dr. J. Richman, an occupational medicine specialist.

(5) State Farm’s examination consisted of all three separate IME reports. The Arbitrator found that State Farm was obliged to ensure that both Ms. Morelli and Dr. Persi received all three IME reports, as well as receiving State Farm’s determination whether Ms. Morelli had sustained a catastrophic impairment. Where only some of the reports are provided, or a summary of several reports and a finding, the insured’s health practitioner is unable to fully examine and dissect the IMEs and determine what to rebut. (2) Consequently, State Farm had Ms. Morelli seen at an insurer’s medical examination (“IME”) by three medical examiners, Dr. D. Young, psychologist, Dr. B. Clark, physiatrist and Dr. J. Richman, an occupational medicine specialist.

The Arbitrator found that State Farm did not comply with subsection 40(4) because it did not send all of its CAT IME reports to Dr. Persi, having provided only Dr. Clark’s assessment and Dr. Richman’s executive summary.

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Singh and State Farm [+] Arbitration, 2014-02-21, Reg 403/96.

Expenses FSCO 4128.

I also found that State Farm did unreasonably delay the IRBs to which Mrs. Singh was ultimately entitled. It had no reasonable answer for not reconsidering her benefits after May 2, 2008 and relied on defective or incomplete reports to terminate those benefits, hence the special award.