Insured entitled to driving assessment due to defective denial, but other treatment plans dismissed.
The applicant sought statutory accident benefits following a motor vehicle accident.
The Licence Appeal Tribunal found the applicant was entitled to a driving reintegration assessment because the insurer failed to provide a clear and unequivocal denial with sufficient medical reasons, rendering the plan payable once incurred.
However, a physiotherapy treatment plan was denied as not reasonable and necessary, with the adjudicator preferring the contemporaneous medical opinion that the applicant had reached maximal medical improvement.
Additional treatment plans for chiropractic care and assistive devices were dismissed because they were properly denied under section 38(5) of the Schedule while the applicant was subject to the Minor Injury Guideline, a refusal not subject to review.
Claims for an award and interest were also dismissed.
OLATOntario Licence Appeal TribunalDec 2, 2024
