See the doctor or don't get paid!!

In Ontario, it has been ruled that the insurance company does not have to pay for accident benefits if you have failed to see the doctor.

The victim has to attend insurance company examinations at the doctor's office. If you choose not attend, you better have a reasonable explanation.

This ruling was decided by the Financial Services Commission of Ontario (FSCO).

Illiia Troubitsine alleges he was on a Toronto Transit Commission (TTC) bus on November 10th, 2006 when he claims he suffered an injury. The injury was a result of the bus stopping suddenly. Troubitsine alleges that the bus stopped suddenly, resulting in him hitting his face and head on the seat in front of him. The injuries he suffered included his neck, jaw, back, teeth and eyes.

The TTC Insurance Company Limited told Troubistsine that he had to attend medical examinations. This would determine his entitlement to possible income replacement benefits, housekeeping and home maintenance benefits, attendant care benefits, medical and rehabilitation benefits.

Troubitsine did not attend any of the scheduled assessments. Nor did he provide any reasons as to why he failed to show up, 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 FSCO arbitrator stated.

“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).”

So, if you have been hurt, it is in your best interest to attend the medical examinations to help establish the depth of your injury. If you fail to do so, then you can expect to find yourself in the same type of situation as Mr. Troubitsine.

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