Dr. C. Hope

The applicant was injured in a motor vehicle accident and sought a medical benefit for an occupational therapy treatment plan, which the respondent insurer denied.

The Tribunal found that the accident exacerbated the applicant's pre-existing chronic low back pain and caused new impairments, including neck pain and psychological symptoms.

Relying on the medical evidence, including the applicant's treating professionals and several independent assessments, the Tribunal concluded the treatment plan was reasonable and necessary to address her physical and psychological impairments.

The applicant was awarded the medical benefit and interest on overdue payments.

The respondent insurer brought a motion to stay the applicant's LAT application pending her attendance at an occupational therapy catastrophic impairment insurer's examination (OT CAT IE).

The applicant argued she was not required to attend because the insurer's notices denying catastrophic impairment and requesting the IE did not comply with the medical reasons and timeline requirements of section 45(3)(b) of the Schedule.

The Tribunal found that while the insurer's notices were indeed defective and non-compliant, the requested OT CAT IE was still reasonable and necessary to complete a deferred neuropsychological assessment.

The Tribunal granted a four-month stay of the application to allow the insurer to issue a compliant notice and for the applicant to attend the examination.