Insurer ordered to pay physiotherapy, housekeeping benefits, and one assessment cost; other assessments denied for procedural non-compliance.
The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits from her insurer.
The insurer denied a physiotherapy treatment plan, terminated housekeeping benefits, and refused to pay for several medical assessments.
At arbitration, the arbitrator found the physiotherapy treatment plan to be reasonable and necessary, rejecting the insurer's DAC assessor whose opinion improperly relied on vehicle damage estimates.
The arbitrator also reinstated the housekeeping benefits, finding the applicant suffered a substantial inability to perform her pre-accident chores, and preferred the evidence of the applicant and her family over the insurer's occupational therapist.
The arbitrator awarded the cost of one orthopaedic assessment but denied two others because the applicant failed to follow the required pre-approval process.
Interest was awarded on the overdue housekeeping benefits.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJul 7, 2006
