Treatment plans denied as not reasonable and necessary, but incurred costs awarded for non-compliant denial.
The applicant sought statutory accident benefits for an impairment assessment, a physiatry assessment, and a treatment plan for physiotherapy and massage therapy following a motor vehicle accident.
The adjudicator found that the impairment assessment and the physiotherapy treatment plan were not reasonable and necessary, noting the applicant's return to full-time work and independence in self-care.
While the physiatry assessment was also found not to be reasonable and necessary, the adjudicator held that the respondent failed to provide a compliant denial under section 38(8) of the Schedule.
Consequently, the applicant was entitled to the incurred costs of the physiatry assessment along with interest.
OLATOntario Licence Appeal TribunalJul 7, 2020
