Insurer's failure to properly deny treatment plan results in automatic approval; remaining plans denied for lack of causation.
The applicant sought payment for three chiropractic treatment plans and an award under the Statutory Accident Benefits Schedule following a 2017 motor vehicle accident.
The Tribunal found the applicant was entitled to the first treatment plan of $1,423.60 because the insurer failed to provide a proper written denial within the required time limit under section 38 of the Schedule.
The remaining two treatment plans were denied, as the Tribunal accepted the respondent's orthopaedic assessment that the applicant's ongoing shoulder issues, which arose after a significant gap in treatment, were not attributable to the accident.
The claim for an award was dismissed for lack of evidence, but interest was awarded on the approved plan.
OLATOntario Licence Appeal TribunalMay 28, 2024
