Chiropractic treatment plan payable due to insurer's defective notice; other treatment plans denied as unnecessary.
The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for physiotherapy, psychological services, and chiropractic services.
The Tribunal found the applicant failed to prove the physiotherapy and psychological services were reasonable and necessary, preferring the evidence of the respondent's section 44 assessors over the applicant's medical records.
However, the Tribunal ordered the respondent to pay the incurred expenses for the chiropractic treatment plan because the respondent's denial letter failed to provide specific medical reasons, violating the notice requirements under section 38(8) of the Schedule.
The claim for a section 10 award was dismissed as the respondent's conduct was not unreasonable.
OLATOntario Licence Appeal TribunalNov 15, 2024