https://www5.fsco.gov.on.ca/AD/4987
As a brief summary, there is no fundamental disagreement between the parties as to the basic facts; namely, that the Applicant submitted a duly completed Application for Determination of Catastrophic Impairment in August, 2015, and despite repeated follow-up correspondence from the Applicant’s counsel, the Insurer failed to respond to the said application not only within the 10 days required period set out in the Schedulefor its response, but for some months afterward. When the Insurer did finally respond and arrange the usual set of medical examinations pertaining to this type of determination, the Applicant refused to attend for the examinations on the basis that the Insurer was too late in setting them up and as a consequence claimed that the Applicant should be deemed to have been found catastrophically impaired. The Applicant further asserted that its Catastrophic Impairment Assessment, prepared by Dr. Harold Becker, should now prevail and be sufficient for the deeming of catastrophic impairment for the Applicant.
The Insurer, for its part, acknowledged the tardiness of its response to the Application and began paying catastrophic-level benefits, where applicable, to the Applicant on an interim basis while attempting to complete the assessment process set out in the Schedule by issuing notices of examination to the Applicant.
This resulted in an impasse which has continued for over a year at this point. The Applicant claims, in its affidavit evidence, that the Applicant has been denied a variety of essential medical services during this intervening period. By contrast the Insurer, in its affidavit, asserts that they have been paying all medical treatment plans, inclusive of applicable interest, during the period in dispute as an indication of its good faith in dealing with the Applicant.