Insurer breached notice requirement but treatment plan denied as not reasonable and necessary.
The applicant sought statutory accident benefits for psychological treatment following a motor vehicle accident.
The insurer denied the treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the insurer failed to provide notice of its denial within the required 10 business days under section 38(8) of the Schedule, and was therefore prohibited from relying on the MIG limit.
However, the Tribunal ultimately dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the proposed psychological treatment was reasonable and necessary, as the objective medical evidence did not support a significant psychological impairment.
OLATOntario Licence Appeal TribunalMar 27, 2018