Insurer ordered to pay for occupational therapy plans and a $5,500 special award for unreasonable denial.
The applicant was injured in a motor vehicle accident and sought payment for an occupational therapy assessment and treatment plan.
The insurer denied the plans and raised a late defence of double payment at the hearing.
The arbitrator rejected the late defence as trial by ambush and found no actual double payment occurred.
The arbitrator concluded the treatment plans were reasonable and necessary, noting the insurer's assessor admitted her recommendation might have differed had she received all relevant information.
The arbitrator ordered the insurer to pay for the plans, plus interest at 2% per month compounded monthly, and a special award of $5,500 for unreasonably withholding payment.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesOct 17, 2016
