Statutory accident benefits awarded; boilerplate denial notices failed to trigger the two-year limitation period.
The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits for physiotherapy services and an orthopaedic assessment.
The respondent insurer denied the benefits and argued that the claims for two of the treatment plans were statute-barred under the two-year limitation period.
The Tribunal found that the respondent's denial notices contained boilerplate language and failed to provide valid medical reasons, meaning they did not trigger the limitation period.
On the substantive issues, the Tribunal found that the proposed treatment plans and the orthopaedic assessment were reasonable and necessary to address the applicant's ongoing pain and promote a return to normal activities.
The applicant was awarded the claimed benefits and interest on overdue payments.
OLATOntario Licence Appeal TribunalNov 29, 2023
