Insurer must fund 1.5-hour social work sessions but at the $100 hourly rate; special award denied.
The applicant sought payment for a psychological treatment plan following a motor vehicle accident.
The insurer partially approved the plan, reducing the hourly rate to that of a social worker, reducing session lengths to one hour, and denying travel time and extra documentation fees.
The Tribunal found the appropriate hourly rate was $100 for a social worker in private practice, but restored the session length to 1.5 hours as the insurer provided no medical basis for the reduction.
The Tribunal denied travel time and extra documentation fees due to insufficient evidence.
The applicant was awarded the $600 balance with interest, but a claim for a special award was dismissed as the insurer's reliance on the Professional Fees Guideline was not unreasonable.
OLATOntario Licence Appeal TribunalAug 9, 2022
