Insurer ordered to pay for incurred treatments due to defective denial notices, though treatments deemed unnecessary.
The applicant sought medical benefits for physiotherapy and chiropractic treatments following a motor vehicle accident.
The insurer denied the treatment plans.
The Tribunal found that the insurer's initial notices of denial for the first two treatment plans failed to provide adequate medical and other reasons as required by s. 38(8) of the Schedule.
Consequently, under s. 38(11), the insurer was ordered to pay for treatments incurred during the period of non-compliance.
However, the Tribunal concluded that none of the treatment plans were substantively reasonable and necessary, as the applicant had reached maximal medical recovery for his accident-related soft tissue injuries and his ongoing complaints were related to pre-existing conditions.
OLATOntario Licence Appeal TribunalDec 2, 2020
