Application for medical benefits dismissed as the proposed chiropractic treatment was not reasonable and necessary.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic, massage, and active rehabilitation treatment.
The insurer denied the medical benefits, relying on a Designated Assessment Centre report that found only a portion of the treatment was reasonable and necessary, and that a transition to self-directed care was appropriate.
The arbitrator preferred the DAC assessor's opinion over the applicant's treating chiropractors, finding the applicant's experts failed to provide a rationale for the ongoing treatment.
The arbitrator also found that the applicant's right knee pain was unrelated to the accident.
The application for medical benefits was dismissed, and the applicant was found liable to pay the insurer's arbitration expenses.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesApr 3, 2007
