Arbitrator denies request for 100 chiropractic sessions, finding it unreasonable to bypass insurer's ongoing review.
The applicant was injured in motor vehicle accidents and sought payment for 100 sessions of chiropractic and massage therapy under the Statutory Accident Benefits Schedule.
The insurer denied the treatment plans, arguing it was unreasonable to approve such extensive treatment without the ability to monitor progress.
The arbitrator found that the applicant had reached maximum medical recovery and that his ongoing need for treatment was equivalent to his pre-accident usage.
The arbitrator concluded that the requested treatment was not reasonable and necessary, as it bypassed the regulatory scheme allowing insurers to review ongoing care.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesNov 4, 2009
