Insurer ordered to pay partial treatment plans where denial notices lacked adequate medical reasons.
The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer partially denied several treatment plans for physiotherapy and psychological services, as well as visitor expenses.
The Tribunal found that the insurer failed to provide adequate medical reasons under s. 38(8) of the Schedule for one physiotherapy plan, making the balance payable.
The Tribunal also found the applicant was entitled to a higher hourly rate for a psychotherapist in two psychological treatment plans.
The remaining claims for travel, administrative reports, and visitor expenses were dismissed as they were not reasonable and necessary.
No special award was granted.
OLATOntario Licence Appeal TribunalAug 29, 2025
