Insurer ordered to pay chiropractic treatment plan due to non-compliant denial notice under s. 38(8).
The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer denied treatment plans for chiropractic services and a TMJ assessment, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found the applicant failed to meet her burden to be removed from the MIG.
However, the Tribunal ordered the insurer to pay the $804.00 treatment plan for chiropractic services because its denial notice failed to provide sufficient medical reasons as required by s. 38(8) of the Schedule.
The claim for the TMJ assessment was dismissed as the denial notice for that plan was compliant.
Claims for an award under Regulation 664 were also dismissed.
OLATOntario Licence Appeal TribunalJan 9, 2025
