Massage therapy approved for pain control despite maximal recovery; multiple body site therapy denied.
The applicant sought approval for three treatment plans for chiropractic and massage therapy, and payment of the balance of a partially paid treatment plan, following a motor vehicle accident.
The insurer denied the plans on the basis that the applicant had reached maximum medical recovery.
The Licence Appeal Tribunal ordered the insurer to pay the outstanding balance on the partially paid invoices, finding that the clinical notes and records provided sufficient evidence that the services were rendered.
The Tribunal also approved the massage therapy portions of the denied plans for pain control, but denied the multiple body site therapy portions, accepting the insurer's medical examination evidence that the appellant had plateaued and the proposed therapy was not reasonable and necessary.
OLATOntario Licence Appeal TribunalSep 26, 2019
