The applicant was injured in a motor vehicle accident and sought payment for a psychological services treatment plan.
The respondent insurer partially approved the plan but denied the remainder, arguing the proposed 90-minute sessions were not reasonable and necessary.
The Tribunal found that the respondent's denial notice failed to comply with s. 38(8) of the Schedule because it lacked clarity and sufficient detail regarding what additional information was required to justify the longer sessions.
Consequently, the treatment plan was payable in full.
The Tribunal also partially granted the respondent's preliminary motion to strike the applicant's reply submissions, excluding portions that improperly introduced new arguments.
