Chiropractic treatment plans denied as applicant had reached maximum medical recovery and had significant pre-existing conditions.
The applicant sought coverage for four chiropractic treatment plans following a motor vehicle accident.
The respondent denied the plans based on an insurer's examination which concluded the applicant had reached maximum medical recovery.
The adjudicator found that the applicant had significant pre-existing conditions and provided inconsistent reporting regarding his symptoms and ability to work.
Accepting that the applicant's recovery had plateaued, the adjudicator concluded the treatment plans were not reasonable and necessary.
The appeal was dismissed.
OLATOntario Licence Appeal TribunalJul 18, 2018
