If you have a serious Accident Benefits claim in Ontario, there is a good chance you have received a letter from your insurer asking you to attend an assessment. Then another. Then several more, sometimes with doctors and specialists you have never heard of, in disciplines that do not seem connected to the problems you are living with every day.
These are Section 44 insurer examinations, and for many injured people they become one of the most stressful parts of the claim. In serious files, the number and scope of these requests can become a major issue in their own right, especially in claims involving catastrophic impairment, cognitive impairment, complex functional loss, or other challenges.
More insurer assessments are not always better. The key questions are what benefit or issue is being assessed and what evidence is reasonably necessary to address it.
In this article, you will learn:
- What a Section 44 insurer examination is and what the notice must include
- Why serious Accident Benefits claims tend to attract so many assessments
- When the volume and scope of insurer examinations can become part of the problem
- How a strategic legal team responds to Section 44 requests while protecting your claim
What Is a Section 44 Insurer Examination?
A Section 44 insurer examination is an assessment requested by your insurer under Section 44 of the Statutory Accident Benefits Schedule (SABS), the regulation that governs Accident Benefits in Ontario. Insurers use these examinations to help decide whether you are, or continue to be, entitled to a benefit, and in some cases whether your impairment is catastrophic.
A Section 44 examination may involve an in-person assessment or a paper review of your file. Where appropriate, an assessment may be conducted remotely. It may be completed by a physician, psychologist, occupational therapist, chiropractor, another regulated health professional, or a person with expertise in vocational rehabilitation chosen by the insurer. A paper review does not require your attendance.
Attending a properly requested examination is part of the Accident Benefits process, and these requests should be taken seriously. However, they are not unlimited. Section 44(1) of the SABS says an insurer may not require you to undergo examinations more often than is reasonably necessary. The assessment is for the insurer’s evaluation of your claim; it is not a treatment appointment.
What Must a Section 44 Notice Include?
Before requiring an examination, your insurer must give you a Section 44 notice, including a paper review. Under Section 44(5), the notice must identify:
- The medical reasons and any other reasons for the examination
- Whether your attendance is required
- The name of the person or people who will conduct it, any regulated health profession to which they belong, and their titles and designations indicating any specialization
- If your attendance is required, the date, time, and location, including those details for each subsequent day of a multi-day examination
If your attendance is required, Section 44(6) generally requires at least five business days’ notice. If you agree, the examination may take place sooner.
The reasons for the examination matter. They should explain why the insurer needs the assessment in your particular circumstances. A notice that merely asks for “an update”, without explaining what needs to be assessed and why, may be inadequate.
In Hedley v. Aviva Insurance Company of Canada, 2019 ONSC 5318, at paragraph 18, the Divisional Court emphasized that boilerplate medical reasons without a principled rationale grounded fairly in the insured’s file are insufficient. Hedley concerned the reasons given under Section 38(8) for refusing treatment plans; it should not be read as deciding that every request for updated information under Section 44 is invalid.
Is a Section 44 Examination the Same as an Independent Medical Examination?
Not necessarily. Many people search for an “independent medical examination” in Ontario, and insurers sometimes use the same phrase. In Accident Benefits claims, however, the more accurate term is insurer examination.
The assessor is selected and paid by your insurer. That does not mean every assessor is biased, but it does mean the report is one piece of evidence, not the final word on your condition. Assessors remain subject to their applicable professional obligations. Your own treatment providers, your medical records, and the people who see you every day also play an important role, as we explain in our blog on why collateral evidence matters.
Why Do Serious Claims Attract So Many Insurer Examinations?
Serious claims often involve several different medical and functional questions, with substantial long-term support at stake. Claims involving catastrophic impairment, attendant care benefits, and income replacement benefits often lead insurers to request assessments across several disciplines at once.
In a single serious file, an insured person may be asked to attend a physiatrist, an orthopaedic surgeon, a psychiatrist, a neuropsychologist, an occupational therapist, and a vocational assessor, sometimes within a few months. Some of those assessments may be necessary. Others may overlap, repeat earlier work, or have little connection to the benefit being disputed. The number of appointments alone does not establish that the requests are unreasonable; their purpose, timing, overlap, and the available evidence must be considered together.
When Do Too Many Assessments Become Part of the Problem?
For many of our clients, attending assessment after assessment is not just inconvenient; it can be exhausting and, at times, harmful. People living with brain injury, psychological injury, or chronic pain may experience:
- Assessment fatigue: long days of testing and questioning that leave them drained for days afterward
- Symptom flare-ups: increased pain, anxiety, headaches, or cognitive overload following an assessment
- Travel and disruption: long drives, missed treatment, and disrupted routines that are hard to rebuild
- Retelling trauma: repeating the details of the accident and its impact to one stranger after another
There is also a strategic problem: a broad series of examinations can shift the focus of the claim away from the real issue in dispute.
The more reports an insurer collects, the more opportunities there are for small differences in how symptoms or abilities are described. Those differences may reflect fluctuating symptoms, the questions asked, or the conditions of testing. They should be assessed in context rather than automatically treated as evidence that the injured person is unreliable.
For example, another occupational therapy assessment may be justified if new evidence raises a different functional question. Repeating substantially the same assessment shortly after an earlier one, without explaining what remains unresolved, may warrant closer scrutiny.
What Does a Strategic Approach to Section 44 Requests Look Like?
Section 44 requests should not be approached passively. A strong legal team does more than forward notices and confirm appointments. At Foisy & Associates, that means we:
- Identify the actual issues in dispute. What benefit is being challenged, and on what basis? The evidence should be built around that question.
- Review whether each request is reasonably necessary. Does the discipline match the injury and the issue? Has it already been assessed? Has anything materially changed? Would existing records or a paper review answer the question?
- Look at the sequence. Where one issue is central, it may make sense to address it first before agreeing to a wider series of assessments. Any proposed change to the schedule should be addressed with the insurer in writing; raising an objection does not itself cancel an appointment.
- Respond in writing. Where a notice is unclear, incomplete, or does not appear reasonably necessary, those concerns should be raised with the insurer promptly and on the record.
- Protect the client on the day. This can include preparing the client for what to expect and requesting appropriate accommodations in advance, such as breaks, accessible transportation, an interpreter, or the attendance of an aide to assist with physical, cognitive, or emotional needs. The arrangements should be confirmed before the appointment, particularly where standardized testing may be affected.
- Build the claimant’s own evidence. Insurer reports should be tested against evidence from treating providers, independent experts, and the people who see the day-to-day impact of your injuries. We also review whether the assessor addressed the correct benefit test, considered the relevant records, and accurately recorded the client’s history and functional limitations.
The goal is not to avoid assessments, but to ensure that the evidence gathered is fair, relevant, and focused on the issues specific to the claim.
How Should You Prepare for an Insurer Examination?
Explain your symptoms and limitations honestly, using concrete examples from daily life. Describe what you can do, what assistance you need, how long tasks take, and whether activity causes symptoms or requires recovery time. Explain differences between better and worse days. Do not minimize your difficulties or exaggerate them. Ask for clarification if you do not understand a question, and tell the assessor when you need a break or cannot safely complete a task.
What Happens After the Examination?
Under Section 44(11), the insurer must give you a copy of the examination report within 10 business days after receiving it. Review it with your lawyer for factual errors, missing records, and conclusions that do not reflect your day-to-day functioning.
A report that supports a denial does not end your claim; your lawyer can assess the evidence and your options for disputing the decision.
What Happens If You Do Not Attend a Section 44 Examination?
This is where getting legal advice early matters. If an insurer has properly required a reasonably necessary Section 44 examination and you do not attend or otherwise comply, the consequences can be serious. Depending on the benefit and the applicable SABS provisions, non-compliance may affect benefit payments as well as your ability to bring a dispute.
Under Section 55(1)2 of the SABS, non-compliance with a Section 44 examination requested through a compliant notice may prevent you from applying to the Licence Appeal Tribunal to dispute the related benefit. The LAT has barred claims on this basis. Section 55(2) allows the LAT to permit an application despite non-compliance, subject to any terms it imposes, but permission is not automatic.
Whether an examination is reasonably necessary depends on the circumstances, including its timing, previous assessments, the connection to the injuries and benefit in question, and whether existing records or a paper review would suffice. Do not refuse or ignore a notice on your own. Speak with a lawyer first. If illness or an emergency prevents attendance, notify your lawyer or insurer promptly, provide supporting information where available, and request written confirmation of a new appointment. Do not assume that an objection or rescheduling request extends the time limit for disputing a denial.
How Foisy & Associates Can Help
Foisy & Associates focuses on serious and complex Accident Benefits claims, including catastrophic impairment, income replacement benefits after the first 104 weeks, and attendant care disputes. Because we limit the number of cases we take on, our team has the time to review every Section 44 request, identify the real issues, and push back when requests go beyond what is reasonably necessary. When disputes reach the Licence Appeal Tribunal, we are ready to represent you at the LAT with the expert evidence your case needs.
If you or someone you love is facing multiple insurer examinations in a serious Accident Benefits claim, contact Foisy & Associates for a free consultation. We will help you understand what is being requested, why, and how to protect your claim.
Frequently Asked Questions About Section 44 Insurer Examinations
Do I have to attend an insurer examination in Ontario?
If your insurer properly requires a reasonably necessary Section 44 examination and your attendance is required, you generally must attend. Not attending can affect your benefits and your ability to dispute a denial at the Licence Appeal Tribunal. If you have concerns about a notice, speak with a lawyer before the appointment.
What happens if I miss a Section 44 examination?
Missing a properly required examination can affect your benefits and may prevent you from pursuing the related dispute at the LAT. The Tribunal can permit an application despite non-compliance, but you should not assume it will do so. If illness or an emergency prevents attendance, notify your insurer or lawyer promptly and request written confirmation of rescheduling.
How many insurer examinations can an insurer request?
There is no fixed number. The SABS says an insurer may not require examinations more often than is reasonably necessary. Whether a request is reasonable depends on the issue in dispute, what has already been assessed, and the connection between the examination and your injuries.
Are insurer examinations independent?
The assessor is chosen and paid by your insurer, so the report should be treated as one piece of evidence rather than the final word. Your treating providers and other evidence can respond to it, and the LAT weighs all of the evidence when deciding a dispute.
