Dr. McKee

The applicant requested a reconsideration of a previous decision that denied a treatment plan for physiotherapy services.

The Tribunal found that it had committed a clear error of fact and law by relying on incorrect submissions that addressed a psychological treatment plan not in dispute.

Upon reviewing the correct submissions, the Tribunal found that the applicant had demonstrated on a balance of probabilities that the $2,486.45 physiotherapy treatment plan was reasonable and necessary to address her chronic pain and functional limitations.

The Tribunal preferred the evidence of the applicant's experts over the respondent's section 44 assessor, noting the latter failed to contemplate a chronic pain diagnosis.

The request for reconsideration was granted and the treatment plan was approved.

Following an arbitration decision regarding statutory accident benefits where the applicant achieved a greater degree of success, the applicant sought expenses.

The arbitrator considered the criteria under the Insurance Act and the Dispute Resolution Practice Code, noting the insurer's failure to respond to settlement offers and refusal to engage in settlement discussions.

The arbitrator awarded the applicant expenses fixed at $12,037.37, inclusive of fees, disbursements, and HST.

The applicant was injured in a motor vehicle accident and sought payment for chiropractic and massage therapy treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer denied the plans based on insurer's examinations.

The Tribunal found the applicant credible and held that the treatment plans were reasonable and necessary as they provided temporary pain relief that allowed the applicant to maintain workplace attendance and perform daily activities.

The Tribunal placed less weight on the insurer's examinations, finding them unhelpful or taken out of context.

The applicant was awarded the cost of the treatment plans and interest on overdue payments.