The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.
The applicant disputed the denial of three treatment plans (OCF-18s) for psychological services, a pre-screen assessment, and chiropractic/massage/acupuncture services.
The Tribunal found that the respondent's denial of the psychological and pre-screen OCF-18s was non-compliant with s. 38(8) of the Schedule, entitling the applicant to the incurred amounts starting on the 11th business day after receipt.
However, the Tribunal declined to deem the expenses incurred under s. 3(8), finding the applicant contributed significantly to the delay.
The Tribunal also dismissed the claim for the chiropractic/massage/acupuncture OCF-18, finding the applicant failed to prove it was reasonable and necessary.