Insurer ordered to pay incurred treatment plans and a 25% award due to defective denial notices.
The applicant sought various statutory accident benefits following a motor vehicle accident.
The Tribunal found that the applicant was not entitled to the disputed physiotherapy, massage, and orthopaedic assessment plans, as they were not shown to be reasonable and necessary.
However, the Tribunal ordered the respondent to pay for two incurred treatment plans for chiropractic and physiotherapy services because the respondent's denial notices failed to comply with s. 38(8) of the Schedule.
The Tribunal also granted a 25% award under s. 10 of O. Reg. 664 on the incurred plans, finding the respondent's conduct in relying on an IE that did not address the disputed plans to be imprudent and inflexible.
OLATOntario Licence Appeal TribunalJun 29, 2023