Application for orthopedic assessment treatment plan dismissed as applicant failed to prove it was reasonable and necessary.
The applicant sought entitlement to a $2,460 treatment plan for an orthopedic assessment following a motor vehicle accident.
The insurer denied the plan based on insurer's examinations (IEs) concluding the applicant's injuries fell within the Minor Injury Guideline and the assessment was not reasonable and necessary.
The Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical records supporting ongoing complaints and gave little weight to the applicant's expert who conducted a virtual assessment based solely on self-reporting.
The Tribunal accepted the in-person IE assessments which found only minor soft tissue injuries.
OLATOntario Licence Appeal TribunalApr 24, 2025
