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Insurer Not Liable For AB When Claimant Fails To Attend Examinations


June 1, 2009   by Claims Canada


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An insurer is not liable to pay for accident benefits when the accident victim has failed to attend insurer examinations without a reasonable explanation, a Financial Services Commission of Ontario (FSCO) arbitrator has decided.

Illiia Troubitsine alleges he was on a TTC bus on Nov. 10, 2006 when he claims the bus stopped suddenly and that he hit his face and head on the seat in front of him and sustained injuries to his back, neck, jaw, teeth and eyes.

TTC Insurance Company Limited advised Troubitsine that examinations had been set up to determine his entitlement to income replacement benefits, attendant care benefits, housekeeping and home maintenance benefits and medical and rehabilitation benefits.

He failed to attend any of the scheduled assessments or provide reasons as to why, FSCO wrote in its arbitration decision.

“As a result of Mr. Troubitsine’s failure to attend insurer examinations without a reasonable explanation, TTC is not liable to pay Mr. Troubitsine for income replacement benefits, attendant care benefits, housekeeping and home maintenance benefits and medical and rehabilitation benefits for the period from Feb. 27, 2007 to Nov. 10, 2008,” the arbitrator wrote.

“As a result of Mr. Troubitsine’s failure to attend scheduled examinations under oath without a reasonable explanation, TTC is entitled to rely upon section 33(2) of the Schedule and is not liable to pay benefits from Jan. 22, 2007 to June 15, 2007 and then ongoing from Nov. 1, 2007 until such time as Mr. Troubitsine complies with section 33(1.1).”


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