Insured awarded medical benefits, assessments, and a 50% special award for unreasonably withheld payments.
The applicant sought statutory accident benefits for physiotherapy services and orthopaedic and psychiatric assessments following a motor vehicle accident.
The respondent insurer denied the claims based on insurer examinations.
The adjudicator found that the physiotherapy services were reasonable and necessary for managing the applicant's chronic pain, rejecting the insurer's argument that treatment must lead to full recovery.
The adjudicator also approved the assessments, noting the insurer's assessors conducted paper reviews without reviewing key medical reports.
Finding that the insurer unreasonably withheld payments, the adjudicator ordered a special award of 50% of the disputed amounts, plus interest.
OLATOntario Licence Appeal TribunalSep 8, 2017
