Accident benefits largely denied due to lack of credibility, but six treatment plans deemed approved.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to 29 treatment plans, attendant care, housekeeping, and examination costs.
The arbitrator found the applicant lacked credibility, noting he minimized pre-accident health issues and submitted false invoices.
The arbitrator rejected the applicant's expert evidence and found the claimed treatments were not reasonable or necessary.
However, six treatment plans totaling $6,398.23 were payable because the insurer failed to respond to them, resulting in deemed approval under the Schedule.
All other claims were dismissed.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesAug 12, 2013
