Insurer ordered to pay for treatment plans after failing to provide adequate medical reasons for denial.
The applicant sought reconsideration of a Tribunal decision dismissing her application for accident benefits.
The insurer had denied two Treatment and Assessment Plans and requested insurer examinations, providing only general statements that the medical documentation did not support the need for treatment.
The Executive Chair found that the insurer failed to satisfy the notice requirements under s. 38(8) of the Statutory Accident Benefits Schedule, as it did not provide specific medical reasons based on the applicant's file.
Consequently, under s. 38(11)2, the insurer was ordered to pay for the disputed benefits.
The request for a special award was denied.
OLATOntario Licence Appeal TribunalApr 5, 2018
