2 total
Physiotherapy treatment plan approved; treating physician's evidence preferred over insurer's paper review.
The applicant was injured in a motor vehicle accident and sought $3,000.22 for a physiotherapy treatment plan under the Statutory Accident Benefits Schedule.
The insurer denied the benefit.
The Licence Appeal Tribunal found the treatment plan reasonable and necessary to assist in relieving the applicant's chronic pain, preferring the evidence of the applicant's treating family doctor and physiotherapist over the insurer's paper review.
The Tribunal ordered the insurer to pay the treatment plan amount plus interest.
Application for medical benefits dismissed due to applicant's failure to attend insurer's examination.
The applicant sought payment for five OCF-6 claims for prescription medication, medical cannabis, and parking expenses following a motor vehicle accident.
The respondent denied the claims and requested the applicant attend an insurer's examination (IE), which she refused.
The Tribunal found that the applicant was barred from proceeding with her application under s. 55(1) of the Schedule due to her failure to attend the IE.
Furthermore, the Tribunal held that the applicant failed to prove the expenses were reasonable and necessary, noting pre-existing pain issues that raised causation concerns.
The application was dismissed.
