Insurer's failure to provide reasons for partial denial of treatment plan breaches s. 38(8) of the Schedule.
The applicant sought statutory accident benefits for psychological and chiropractic services following a motor vehicle accident.
The respondent partially denied several treatment plans, arguing that psychotherapists are not entitled to the higher hourly rate of psychologists under the Professional Services Guideline.
The Tribunal found that the applicant failed to establish that the higher rate was reasonable and necessary.
However, the Tribunal found that one of the respondent's denial letters violated s. 38(8) of the Schedule by failing to provide reasons for the partial denial, entitling the applicant to $637.07 for that plan.
The remaining claims were dismissed, including two that were barred by the two-year limitation period.
OLATOntario Licence Appeal TribunalDec 30, 2025
