Dr. Darrel Ogilvie-Harris

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that had approved a $2,460 orthopaedic assessment treatment plan.

The Vice-Chair granted the reconsideration, finding that the initial adjudicator committed a material breach of procedural fairness by failing to provide adequate reasons for why the treatment plan was reasonable and necessary, focusing instead on the Minor Injury Guideline.

Upon rehearing the matter, the Vice-Chair dismissed the application for the treatment plan.

The Vice-Chair concluded that the applicant failed to establish that an orthopaedic assessment conducted entirely over the telephone, without any visual or video component, was reasonable and necessary to identify impairments or increase range of motion.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer denied a $2,460 treatment plan for an orthopedic assessment, arguing the applicant's injuries were predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The Tribunal found that the applicant had developed chronic pain syndrome, satisfying four of the six criteria under the AMA Guides, which warranted removal from the MIG.

The Tribunal concluded the proposed orthopedic assessment was reasonable and necessary, ordering the respondent to pay the treatment plan amount plus interest.