Insurer ordered to pay for treatment incurred during notice non-compliance period; substantive treatment plans denied.
The applicant sought payment for five chiropractic treatment plans following a motor vehicle accident.
The Licence Appeal Tribunal found that the insurer failed to comply with the 10-day notice requirement under section 38(8) of the Schedule for three of the plans, ordering the insurer to pay for treatment incurred during the non-compliance periods.
However, the Tribunal dismissed the appeal regarding the substantive entitlement to the treatment plans, finding the applicant failed to prove they were reasonable and necessary.
The objective medical evidence and independent assessments indicated the applicant had reached maximum medical recovery and would not benefit from further facility-based treatment.
OLATOntario Licence Appeal TribunalAug 23, 2019
