Insurer ordered to pay portion of massage therapy treatment plan due to defective denial notice.
The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer denied treatment plans for massage therapy and a chronic pain assessment, arguing the applicant's injuries were caused by pre-existing conditions and prior accidents.
The Tribunal found that the accident caused the applicant's neck, back, shoulder, and rib injuries, but not his hip complaints.
The Tribunal held that the insurer failed to provide a compliant denial notice for the massage therapy treatment plan within the required 10 business days under s. 38(8) of the Schedule.
As a result, the insurer was ordered to pay $384.05 for the period of non-compliance pursuant to s. 38(11).
The remainder of the massage therapy and the chronic pain assessment were denied as not reasonable and necessary.
OLATOntario Licence Appeal TribunalJan 19, 2021
