Chronic pain assessment found reasonable and necessary; insurer's paper review given less weight than treating practitioners.
The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $1,765.20 for a chronic pain assessment.
The respondent insurer denied the claim based on a paper review by a physiatrist who opined that further psychological treatment alone was sufficient.
The Tribunal found the applicant's evidence, including assessments from treating practitioners and a chronic pain assessment report, to be more persuasive than the insurer's paper review.
The Tribunal held that the chronic pain assessment was reasonable and necessary, and awarded the cost of the examination along with interest on the overdue payment.
The respondent's procedural defence regarding an unsigned treatment plan was dismissed as the insurer had waived the requirement by scheduling an examination.
OLATOntario Licence Appeal TribunalJul 24, 2018
