Insurer ordered to pay medical benefits and interest after DAC report rejecting treatment was given little weight.
The applicant was injured in a motor vehicle accident and sought payment for $1,828.00 in medical benefits for treatment received at a health clinic.
The insurer denied the treatment plan based on perceived 'red flags' and a subsequent Designated Assessment Centre (DAC) report that concluded the treatment was not reasonable and necessary.
The arbitrator gave little weight to the DAC report due to factual errors and internal inconsistencies, preferring the evidence of the treating chiropractor and the applicant.
The arbitrator found the treatment was reasonable and necessary, ordered the insurer to pay the medical benefit with interest, and deferred the issues of a special award and expenses to a resumed hearing.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesMar 15, 2007
