Physiotherapy treatment plans including Pilates approved at unregulated provider rates; occupational therapy assessment denied.
The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming two treatment plans for physiotherapy (Pilates and massage therapy) and one for an occupational therapy assessment.
The adjudicator found the physiotherapy treatment plans reasonable and necessary to alleviate pain and improve function, preferring the evidence of the applicant's treating and assessing practitioners over the insurer's examination assessor.
However, the hourly rate for the Pilates instructor was reduced to the unregulated provider rate, and the second plan was subject to deduction for available collateral benefits.
The claim for an occupational therapy assessment was dismissed as the adjudicator found it was not reasonable and necessary, relying on a recent comprehensive functional capacity evaluation.
OLATOntario Licence Appeal TribunalJul 14, 2020
