Application for accident benefits dismissed as proposed treatment plans were not reasonable and necessary.
The applicant sought payment for six treatment plans (OCF-18s) for chiropractic, massage, and physiotherapy services following a motor vehicle accident.
The respondent insurer denied the plans on the basis that the applicant had reached maximum medical improvement and the proposed treatment was not reasonable and necessary.
The Licence Appeal Tribunal found that the applicant suffered soft tissue injuries and a thumb ligament strain, but failed to establish that the ongoing facility-based treatment was effective or necessary.
The Tribunal noted that the applicant did not follow specific treatment recommendations from a specialist for his thumb injury, and that clinical records did not support ongoing debilitating chronic pain.
The application was dismissed, and no interest was payable.
OLATOntario Licence Appeal TribunalAug 11, 2022
