Treatment plans payable due to insurer's deficient denial notices; worksite assessment found reasonable and necessary.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied several treatment plans for physiotherapy, massage, chiropractic services, and a worksite assessment.
The Tribunal found that the respondent's denial notices for the treatment plans were non-compliant with s. 38(8) of the Schedule because they lacked adequate medical reasons.
Applying the Divisional Court's decision in Suarez, the Tribunal held that the treatment plans were payable once incurred.
The Tribunal also found the worksite assessment to be reasonable and necessary based on the applicant's consistent reporting of back pain aggravated by prolonged sitting.
The applicant's claim for a bad faith award under s. 10 of O. Reg. 664 was dismissed, as the respondent's reliance on its assessors' reports was not unreasonable.
OLATOntario Licence Appeal TribunalMay 15, 2024
