Arbitrator significantly reduces statutory accident benefits payable for assessment and treatment due to excessive facility billing.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for the cost of a multidisciplinary assessment and a subsequent treatment program provided by a rehabilitation facility.
The insurer disputed the necessity of the treatment and the reasonableness of the costs, and argued the arbitration was improperly brought by the facility rather than the insured.
The arbitrator found the arbitration was properly instituted.
On the merits, the arbitrator accepted that the applicant suffered from physical and psychological impairments, making the assessment and treatment plan reasonable in principle.
However, the arbitrator found the facility's billing practices to be highly excessive, redundant, and unreasonable.
The arbitrator significantly reduced the amounts payable for both the assessment and the treatment program, and declined to order a special award against the insurer.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJul 22, 1998
