Treatment plans and chronic pain assessment approved; insurer's independent medical examination rejected due to internal contradictions.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The respondent insurer denied portions of treatment plans for chiropractic and physiotherapy, as well as a chronic pain assessment.
The Tribunal found that the respondent failed to provide a proper denial with medical and other reasons for the first treatment plan, triggering the consequences of s. 38(11) of the Schedule.
For the remaining treatment plan and assessment, the Tribunal preferred the applicant's medical evidence, finding the respondent's independent medical examination contained internal contradictions.
The Tribunal concluded the treatment and assessment were reasonable and necessary, ordering the respondent to pay the disputed amounts plus interest.
Raees v. Aviva Insurance Canada, 2022 CanLII 78894
