Frequency Of Section 44 Insurer Examinations

In an accident benefits dispute, under section 44 of the Statutory Accident Benefits Schedule (the "Schedule"), insurers have the right to require an Applicant to undergo a medical examination "not more often than is reasonably necessary".

In the leading decision of Hameed Al-Shimasawi v Wawanesa Mutual Insurance Company, the Ontario Insurance Commission (the "Commission") provided guidance on the frequency of insurer's examinations.

The Commission stated in determining whether an insurer's examination is required, the insurer has the onus to establish that the proposed examination is reasonable by answering the following question,

Given the information already available, does the insurer reasonably require this examination in order to assess the validity of a claim to ongoing benefits or in response to a new claim (rather than for purposes of trial brinkmanship or an attempt to bolster the insurer's position)?