Tribunal denies most accident benefit claims because expenses were incurred before submitting treatment plans or were experimental.
The applicant, who sustained catastrophic impairments in a motor vehicle accident, sought payment for various medical and rehabilitation benefits, including a 3D mattress system, a portable modulation stimulator, naturopathic treatments, and an infrared sauna.
The respondent denied the claims primarily on the basis that the expenses were incurred prior to the submission of treatment plans (OCF-18s) or were experimental and not reasonable and necessary.
The Tribunal found that section 38 of the Schedule barred recovery for most of the expenses incurred prior to submission.
The Tribunal also accepted the respondent's expert evidence that certain treatments were experimental.
The application was allowed in part for an eye exam and specific wellness products, but the majority of the claims and the request for costs were dismissed.
OLATOntario Licence Appeal TribunalMay 28, 2021
