Insurer ordered to pay for orthopedic assessment after failing to provide proper medical reasons for denial.
The applicant, a cyclist injured in a motor vehicle accident, sought the cost of an orthopedic assessment under the Statutory Accident Benefits Schedule.
The respondent denied the treatment plan, suggesting alternative treatment (cortisone injections) based on a physiatrist's report.
The Tribunal found that the respondent failed to provide a proper medical reason for denying the assessment as required by section 38(8) of the Schedule, meaning the benefit was payable under section 38(11).
Furthermore, the Tribunal found the assessment was reasonable and necessary given the nature of the collision and the applicant's injuries.
The applicant was awarded the cost of the examination up to the $2,000 limit, plus $200 for the preparation of the treatment plan, HST, and interest.
OLATOntario Licence Appeal TribunalFeb 6, 2018
