Insurer's defective notice precluded MIG reliance, but treatment plan denied as not reasonable and necessary.
The applicant sought statutory accident benefits following a rear-end motor vehicle collision.
The insurer denied a $5,185 treatment plan for chiropractic services on the basis of insurer examinations.
The Tribunal found that the insurer's denial notice failed to comply with s. 38(8) of the SABS because it did not state whether the MIG applied, precluding the insurer from relying on the MIG limit.
However, the Tribunal concluded the proposed treatment was not reasonable and necessary, preferring the evidence of the insurer's assessors that the applicant's accident-related injuries had resolved and his ongoing complaints stemmed from pre-existing degenerative disc disease.
Due to the defective notice, the insurer was ordered to pay any amounts the applicant had already expended on the treatment plan.
OLATOntario Licence Appeal TribunalApr 13, 2020
