N. A. V. v. Motor Vehicle Accident Claims Fund (MVACF), 2020 CanLII 40353

Citation: N. A. V. vs. Motor Vehicle Accident Claims Fund (MVACF), 2020 ONLAT 19-001831/AABS

Released Date: 05/29/2020

In the matter of an Application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8., in relation to statutory accident benefits.

Between:

N. A. V.

Applicant

and

Motor Vehicle Accident Claims Fund (MVACF)

Respondent

DECISION

ADJUDICATOR: Rebecca Hines

APPEARANCES:

For the Applicant: Ryan St. Aubin, Counsel

For the Respondent: Daniel Fenwick, Counsel

HEARD: In person on November 1, 2019 and By way of written submissions

OVERVIEW

1N. V. (the "applicant") was involved in an automobile accident on January 3, 2015. Since she did not have insurance, she applied for accident benefits to the Motor Vehicle Accident Claims Fund (the "respondent") under the Statutory Accident Benefit Schedule – Effective September 1, 2010¹ (the "Schedule"). The respondent provides payment of benefits to injured people who do not have automobile insurance.

2The respondent denied several benefits and the applicant submitted an application to the Licence Appeal Tribunal – Automobile Accident Benefit Services (the "Tribunal"). The parties were unable to resolve this dispute at a case conference and the matter proceeded to a combination hearing. A half day in-person hearing was held on November 1, 2019, in which the applicant was cross-examined on her affidavit, followed by written submissions which concluded on January 6, 2020. There were a few procedural delays as the Tribunal was missing a portion of the applicant's document brief. Further, the Tribunal was missing the full treatment plans relating to the issues in dispute.

ISSUES

3I have been asked to decide the following issues:

i. Is the applicant entitled to a medical benefit in the amount of $5,086.80 for psychological treatment recommended by Nicole McCance Psychology Professional Corporation in a treatment plan (OCF-18) submitted on April 28, 2016 and denied on April 28, 2016?

ii. Is the applicant entitled to a medical benefit in the amount of $3,014.54 for psychological services recommended by Leanne Wagner Counselling in an OCF-18 submitted on February 3, 2017 and denied on February 8, 2017?

iii. Is the applicant entitled to a medical benefit in the amount of $448.83 ($2,743.37 less $2,294.54 approved) for psychological services recommended by Injury Management and Medical Assessments in an OCF-18 submitted on December 15, 2016 and denied on January 12, 2017?

iv. Is the applicant entitled to the cost of a neuropsychological assessment in the amount of $4,400.00 recommended by Injury Management and Medical Assessments in an OCF-18 submitted on August 2, 2016 and denied on August 19, 2016?

v. Is the applicant entitled to a medical benefit in the amount of $2,392.00 for chiropractic services recommended by Multi-Rehabilitation Services in an OCF-18 submitted on September 19, 2017 and denied on September 29, 2017?

vi. Is the applicant entitled to a medical benefit in the amount of $2,343.00 ($3,593.00 less $1,250.00 approved) for chiropractic services recommended by Multi Rehabilitation Services Inc., in an OCF-18 submitted on February 27, 2017 and denied on March 17, 2017?

vii. Is the applicant entitled to a medical benefit in the amount of $960.31 ($2,544.89 less $1,584.58 approved) for medication submitted in an OCF-6 on July 22, 2016 and denied on July 26, 2016?

viii. Is the applicant entitled to a medical benefit in the amount of $2,015.21 for medication submitted in an OCF-6 on September 23, 2017 and denied on September 29, 2017?

ix. Is the applicant entitled to interest on any overdue payment of benefits?

x. Is the respondent entitled to costs pursuant to Rule 19 of the Licence of Appeal Tribunals Common Rules of Practice and Procedure ("Rules")?

RESULT

4After reviewing the parties' submissions and all of the evidence, I find as follows:

i. The applicant is not entitled to payment for the following:

a) A medical benefit in the amount of $5,086.80 for psychological treatment recommended by Nicole McCance Psychology Professional Corporation in a treatment plan (OCF-18) submitted on April 28, 2016 and denied on April 28, 2016;

b) A medical benefit in the amount of $3,014.54 for psychological services recommended by Leanne Wagner Counselling in an OCF-18 submitted on February 3, 2017 and denied on February 8, 2017; and,

c) The balance of $2,200.00 for the cost of a neuropsychological assessment in the amount of $4,400.00 ($2,200.00 approved) recommended by Injury Management and Medical Assessments in an OCF-18 submitted on August 2, 2016 and denied on August 19, 2016.

ii. The applicant is entitled to payment for the following:

a) A medical benefit in the amount of $448.83 ($2,743.37 less $2,294.54 approved) for psychological services recommended by Injury Management and Medical Assessments ("Injury Management") in an OCF-18 submitted on December 15, 2016 and denied on January 12, 2017;

b) A medical benefit in the amount of $2,392.00 for chiropractic services recommended by Multi-Rehabilitation Services in an OCF-18 submitted on September 19, 2017 and denied on September 29, 2017;

c) A medical benefit in the amount of $2,343.00 ($3,593.00 less $1,250.00 approved) for chiropractic services recommended by Multi Rehabilitation Services Inc., in an OCF-18 submitted on February 27, 2017 and denied on March 17, 2017;

d) A medical benefit in the amount of $960.31 ($2,544.89 less $1,584.58 approved) for medication submitted in an OCF-6 on July 22, 2016 and denied on July 26, 2016;

e) A medical benefit in the amount of $2,015.21 for medication submitted in an OCF-6 on September 23, 2017 and denied on September 29, 2017; and,

f) Interest on any overdue payment of benefits pursuant to the Schedule. The applicant is not entitled to interest on issues d) and e).

iii. The respondent is not entitled to costs pursuant to Rule 19.

BACKGROUND

5On January 3, 2015, the applicant was a pedestrian who was hit by a taxi while crossing at a traffic light. She maintains that she fell to the ground onto her left side and injured her left elbow, low back, left leg and head. The taxi did not remain at the scene and the police were not called. The applicant was assisted to her feet by onlookers and she was able to walk. Shortly after the accident she attended the police station to report the incident and attended her family doctor's office a few days following the accident.

6Prior to the accident, the applicant held two part-time jobs in a chocolate factory and bakery. She also volunteered at a community centre offering assistance and companionship to elderly adults. Following the accident, she contends that she has worked reduced hours on modified duties out of necessity because she is the sole breadwinner for her and her 22 year-old autistic son. She maintains that the treatment she has incurred to date has helped her function in her employment and daily activities.

7The applicant was removed from the Minor Injury Guideline ("MIG") as a result of an accident-related psychological impairment. She argues that she is entitled to all of the disputed treatment plans because she suffers from chronic pain to her left elbow and back, as well as depression and pedestrian anxiety as a result of the accident. The applicant maintains that she has incurred all of the above treatment plans because the treatment has relieved her pain and helped her function in her employment.

8The respondent argues that the applicant is not entitled to the two treatment plans for psychological treatment as she failed to submit signed treated plans. Further, the third treatment plan for psychological treatment was excessive and did not comply with the fees outlined in the Professional Services Guideline ("Guideline").

9In addition, the respondent maintains that the applicant misrepresented her medical condition in her application for accident benefits as she was not honest with the psychological assessors about her pre-accident medical history. It argues that the applicant's psychological condition was not caused by the accident. Instead, the first onset of her psychological complaints coincided with a case involving a sexual assault on one of the applicant's family members and pending court case.

10The respondent also submits that the applicant did not report a second accident which happened in November 2016, in which she was hit by another vehicle as a pedestrian. Moreover, even though the applicant was removed from the MIG as a result of a psychological impairment, the physical impairments she sustained in the accident are minor. Therefore, treatment for her physical impairments is capped at the $3500 MIG limits. Finally, it has not been able to properly address the expense forms submitted for medication because, as to date, the applicant has not submitted the invoices for same and her family doctor has not responded to its request for additional information.

ANALYSIS:

11Prior to addressing whether the applicant is entitled to each treatment plan I will first address the respondent's allegation that the applicant misrepresented her medical condition in her application for accident benefits. Specifically, that she was not forthcoming about an incident involving her family member being sexually assaulted and pending court case which coincided with the timing of the accident and her psychological complaints. Further, that she did not disclose being involved in a second accident in November 2016 in which she was hit again by a vehicle as a pedestrian.

12While I agree with the respondent that the applicant should have been honest with the psychological assessors about the incident involving the sexual assault and its impact, I can understand why she did not as it was an extremely personal and traumatic life event. Further, as a lay person the applicant may not have understood the significance of this event in reporting her accident related impairments. Having said that, I find that the accident caused the applicant's psychological impairments as there are multiple references throughout the medical records regarding the applicant suffering from pedestrian anxiety and depression as a result of physical pain post-accident.

13The applicant also submitted the pre-accident clinical notes and records ("CNRS") from the [clinic] in which the applicant has been a patient since April 2014 to date. These records demonstrate that while the applicant sought counselling and support for herself and her family member arising from the sexual assault, she was not prescribed any medication to address any psychological complaints as a result. Further, the CNRs reflect that while the incident caused her significant stress her main objective was to improve communication with the family member assaulted and receive services for them. In contrast, following the accident, the applicant was prescribed medications by Dr. Goncalves, her family doctor for pain, anxiety and to assist with sleep. Furthermore, several assessors diagnosed the applicant with a psychological impairment as a result of the accident. Therefore, I am satisfied that the accident caused the psychological complaints put forth by the applicant in this claim.

14In regard to the applicant's failure to report her involvement in a second accident in November 2016, the applicant maintains that this accident was not as severe and did not cause any impairments. This is supported by the fact that only one reference is made to this accident in Dr. Goncalves's CNRs. The CNRs state that the vehicle made contact with her foot and leg. The record supports that the incident increased the applicant's anxiety. However, Dr. Goncalves did not refer the applicant for any x-rays or note any injuries. Further, there were no follow ups or treatment required in relation to this accident. I agree with the applicant that the medical documentation does not support that she suffered from any significant impairments as a result of the second accident as no medical documentation was submitted to support the respondent's position. As a result, I find that the subject accident caused the applicant's physical impairments.

Psychological Treatment

i) Is the applicant entitled to a medical benefit in the amount of $5,086.80 for psychological treatment recommended by Nicole McCance Psychology Professional Corporation in a treatment plan (OCF-18) submitted on April 28, 2016 and denied on April 28, 2016?

15Section 14 and 15 of the Schedule provide that an insurer is only liable to pay for medical expenses that are reasonable and necessary as a result of an accident. The applicant bears the onus of proving on a balance of probabilities that any claimed medical expenses are reasonable and necessary.

16I find the applicant is not entitled to payment for this treatment plan.

17Section 38(2) of the Schedule provides that an insurer is not liable to pay for a treatment plan if the insured does not comply with the requirements of s.38(3). Section 38(3)(a) requires that a treatment plan submitted to the insurer be signed by the insured person unless the insurer waives that requirement.

18The respondent denied the treatment plan on the basis that it was not signed by the applicant. In its explanation of benefits dated April 28, 2016, it requested that the applicant and service provider submit a signed treatment plan for consideration. The respondent sent a follow up request and to date the applicant has not complied. The treatment plan submitted as evidence was not signed by the applicant. In her reply submissions, no explanation was provided for why she failed to comply with the respondent's request to submit a signed treatment plan.

19Therefore, I find that the applicant is not entitled to payment for this treatment plan as she was in non-compliance with s.38(3)(a) of the Schedule.

ii) Is the applicant entitled to a medical benefit in the amount of $3,014.54 for psychological services recommended by Leanne Wagner Counselling in an OCF-18 submitted on February 3, 2017 and denied on February 8, 2017?

20I find the applicant is not entitled to payment for this treatment plan.

21The respondent also denied this treatment plan on the basis that it was not signed by the applicant. In its explanation of benefits dated February 8, 2017, it requested that the applicant sign the treatment plan and resubmit for consideration. To date the applicant has not complied with this request. Further, no explanation was provided in her reply submissions for why she failed to comply with the respondent's request to submit a signed treatment plan. As already highlighted above the respondent denied this treatment plan on the basis that the applicant was in non-compliance with s.38(3)(a).

22Consequently, I find the applicant is not entitled to payment of this treatment plan as she was in non-compliance with s.38(3)(a) of the Schedule.

iii) Is the applicant entitled to a medical benefit in the amount of $448.83 ($2,743.37 less $2,294.54 approved) for psychological services recommended by Injury Management in an OCF-18 submitted on December 15, 2016 and denied on January 12, 2017?

23I find the applicant is entitled to payment of the balance of this treatment plan in the amount of $448.83.

24The applicant submitted the treatment plan of Injury Management which recommended 14 sessions of psychological treatment for the total cost of $149.61 per session, totalling $2,094.34. Further, it included $448.83 for preparing a progress report in which it allotted 3 hours. As a result of the accident, the applicant was diagnosed with Adjustment Disorder with Mixed Anxiety and Depressed Mood, Situational Phobia (travelling) and post-traumatic stress disorder. These diagnoses were made by Dr. Valentin as well as by the IE assessors. Moreover, all of the assessors (including IE assessors) recommended that the applicant receive some level of psychological treatment.

25The respondent partially approved this treatment plan in the amount of $2,294.54. In its explanation of benefits, it deemed 12 out of 14 psychological sessions reasonable and necessary and determined that the fees charged for reporting was excessive and not in accordance with the Guideline. However, in its explanation of benefits, the respondent did not refer to which Guideline it was relying upon or how the fees were excessive or in non-compliance. Further, the respondent did not elaborate and provide clarification in its written submissions for this hearing. I find that the respondent's denial of this benefit fell short of providing adequate reasons for denying the benefit. In addition, I find that the applicant has met her onus in demonstrating that she sustained a psychological impairment as a result of the accident and that the treatment proposed is reasonable and necessary. Therefore, I find the full treatment plan reasonable and necessary as a result of the accident.

Neurological Assessment

iv) Is the applicant entitled to the cost of a neuropsychological assessment in the amount of $4,400.00 (less $2,200.00 approved) recommended by Injury Management and Medical Assessments in an OCF-18 submitted on August 2, 2016 and denied on August 19, 2016?

26I find the applicant is not entitled to payment for the balance of this neuropsychological assessment.

27Section 25(1)(5) of the Schedule provides a maximum of $2,000.00 payable for each cost of examination expense. Dr. Valentin submitted two treatment plans in the amount of $2,200.00 each for a total cost of $4,400.00 for the neuropsychological assessment. In the additional comment section of the treatment plan Dr. Valentin notes that the Ontario Psychological Association Guidelines for assessments and treatment in auto insurance claims (July 2010) provides that a neuropsychological assessment be done in two parts: one for screening and interview and the other for comprehensive testing.

28The respondent approved the cost of the neuropsychological assessment of Dr. Valentin in the amount of $2,200.00 which included $200.00 for the cost of completing the treatment plan. It maintains that the cost of this assessment is capped in the maximum amount of $2,000.00 provided for in s.25(1)(5) of the Schedule. The applicant's submissions did not focus on why the balance of this treatment plan for the neuropsychological assessment is reasonable or necessary. Further, she did not submit any authority to support that the Tribunal has jurisdiction to award amounts for examination expenses above the $2,000.00 cap provided for in the Schedule.

29Therefore, I find that the applicant is not entitled to payment for the balance of the neuropsychological assessment.

Acupuncture, Massage and Chiropractic Treatment

v) Is the applicant entitled to the two treatment plans for acupuncture, massage, and chiropractic treatment recommended by Multi Rehabilitation Services Inc.?

30I find the applicant is entitled to payment for both treatment plans for acupuncture, massage and chiropractic treatment recommended by Multi Rehabilitation Service.

31The applicant maintains that she still suffers from ongoing chronic pain in her left elbow and low back as a result of the accident. Further, that she has incurred these treatment plans as they provided pain relief and allowed her to function in her two part time jobs at a chocolate factory and bakery. The applicant relied on the treatment plans, as well as the CNRs of the [Community Centre] and Dr. Goncalves in support of her position that the treatment plans are reasonable and necessary.

32The respondent denied funding for both treatment plans as it took the position that the applicant's physical impairments were minor, and that she had achieved maximum medical recovery from facility-based treatment. The respondent maintains that even though the applicant was removed from the MIG as a result of her psychological impairment, the $3500 cap still applies to her claims for physical treatment. The respondent relied on the insurer examination (IE) report of Dr. Ostro, General Practitioner, dated June 15, 2015 who initially assessed the applicant to address whether her accident related physical impairments fit within the MIG. Dr. Ostro opined that the applicant suffered uncomplicated soft tissue injuries to her left elbow and lumbosacral spine. Further, the doctor determined that additional facility-based treatment was not reasonable and necessary. For the reasons that follow, I agree with the applicant and find both treatment plans reasonable and necessary as a result of her accident related impairments.

33First, since the applicant has been removed from the MIG I find the appropriate test to be applied is whether the treatment plans are reasonable and necessary. The applicant was removed from the MIG as a result of a psychological impairment, therefore I find her entitlement to medical benefits is not subject to the $3500.00 cap.

34Second, from the date of the accident until February 2, 2017 the applicant has consistently reported her complaints of pain to the doctors at the [clinic] as well as to Dr. Goncalves. Between September 9, 2016 and February 2, 2017, the applicant attended Dr. Goncalves's office in which she complained of ongoing pain to her left elbow and back. The time period of Dr. Goncalves's CNRs coincide with the dates that the treatment plans were submitted which, in my view, supports the applicant's continued need for treatment during that time period.

35Dr. Goncalves's CNRs also reflect that the treatment the applicant was receiving was beneficial and helping her function in her employment. In a handwritten note dated December 15, 2018, Dr. Goncalves notes that the applicant still had limitations with walking, standing and sitting and decreased range of motion with forward flexion of the lumbar spine. In Dr. Goncalves' opinion the applicant's prognosis was guarded, and she referred the applicant to a physiatrist for further investigation. Dr. Goncalves has also prescribed the applicant various pain medication since the date of the accident. In my view, this supports the applicant's position that her accident related complaints have not resolved and she requires continued physical treatment. The applicant was also consistent in her self-reports of pain to the IE assessors as well as to Dr. Valentin. Further, she consistently maintained that the treatment was assisting her with pain relief and her physical impairments were improving and allowing her to function.

36Third, it is well accepted law that ongoing treatment is considered reasonable and necessary if it relieves an individual's pain and improves their function. Except for the amount and duration of treatment, both treatment plans submitted by Multi Rehabilitation Services Inc. are practically identical. Under Part 8, the treatment plans indicate that the applicant has difficulties with prolonged walking and lifting heavier weights. The applicant also struggles with heavier cleaning tasks and gripping with wrist extension. Under Part 9, the goals of the treatment plans are to increase the applicant's endurance and return her to her pre-accident activities of daily living. I find the goals outlined in these treatment plans to be reasonable objectives.

37The first treatment plan submitted on February 27, 2017 was in the amount of $3,593.00. The respondent approved $1,250.00 based on its position that the applicant had exhausted the $3500.00 for physical treatment. This treatment plan notes that minor gains had been made by the applicant since the last assessment and that the treatment received had enabled her to maintain her current level of function. I find this consistent with what is reflected in Dr. Goncalves's CNRs. Therefore, I find the balance of the treatment plan reasonable and necessary as a result of the applicant's accident related impairment. The second treatment plan submitted on September 19, 2017 was in the amount of $2,392.00 and reduced the number and cost of treatment sessions. Since the applicant's complaints of pain have remained unresolved and she was reporting benefits from treatment, I find this treatment plan reasonable and necessary.

38Finally, much was made by the respondent that the applicant has been inconsistent in reporting how many hours she worked post-accident at her two part-time jobs. I agree with the respondent that the applicant's testimony regarding how many hours she worked post-accident was inconsistent with what she stated in her affidavit. However, I find it irrelevant to the present analysis. In my view the applicant should not be penalized for returning to work. In fact, I find that she has attempted to mitigate her losses and, as the sole breadwinner for her family, she had to return to work out of necessity. The applicant testified that she has required ongoing physical treatment to manage her pain and improve her function which has allowed her to continue working. I believe the applicant as this was consistent with the CNRs of her treating practitioners. As a result, I have given the inconsistent evidence about her post-accident hours of employment little weight.

Prescription Medication

vi) Is the applicant entitled to a medical benefit in the amount of $2,544.89, (less $1,584.58 approved) $960.31 for medication submitted in an OCF-6 on July 22, 2016 and denied on July 26, 2016?

39In its explanation of benefits, the respondent requested that the applicant submit invoices and receipts for the outstanding prescriptions. It is unclear when the prescription summary invoices were provided to the respondent. The applicant failed to submit the OCF-6s with prescription summaries with her document brief for this hearing and only complied when the Tribunal requested that the materials be submitted.

40In its submissions, the respondent confirmed that it was satisfied with the documentation provided and it agreed to pay for the remaining balance relating to this OCF-6. As a result, I do not feel that it is necessary to address whether these prescription expenses are reasonable and necessary. However, since it appears that the applicant was delayed in submitting the supporting documentation to the respondent, I do not order the respondent to pay interest on the amount claimed.

vii) Is the applicant entitled to a medical benefit in the amount of $2,015.21 for medication submitted in an OCF-6 on September 23, 2017 and denied on September 29, 2017?

41The respondent denied this expense on the basis that no invoices were submitted for these prescription expenses. As highlighted above, the OCF-6 and supporting prescription summary was not initially submitted as part of the applicant's written submissions. Nor did the applicant make a specific reference to the various prescriptions outlined in the summary with her written submissions. A pre-accident CNR from [the Clinic] from 2014 provided a list of medication that the applicant was taking prior to the accident which included Atenolol, Synthroid and Alprazolam for pre-existing hypertension and hyperthyroidism. Dr. Goncalves' CNRs confirm that the applicant was prescribed Cymbalta, Tecta, Naproxen, Tylenol 3 and Zoplicone as a result of the accident. The bulk of the prescription summary listed these accident-related medications prescribed by Dr. Goncalves. However, the invoice also listed Atenolol and Eltroxin. No evidence was submitted that the prescriptions for these medications are accident related.

42Therefore, I find the applicant is entitled to payment for the prescription expenses outlined on this prescription summary for Cymbalta, Tecta, Naproxen and Tylenol 3. I do not find the other prescription expenses accident related. I do not find that the applicant is entitled to payment of interest on this expense as it is not clear when the prescription summary invoice was submitted to the respondent.

Costs

viii) Is the respondent entitled to costs pursuant to Rule 19?

43The respondent is not entitled to costs pursuant to Rule 19 of the Licence Appeal Tribunal's Common Rules of Practice and Procedure.

44Rule 19.1 provides that costs may be requested where a party believes another party has acted unreasonably, frivolously, vexatiously or in bad faith during the course of the proceedings.

45The respondent argued that the applicant has acted unreasonably as she brought this application when benefits were correctly denied and for the most part denied because of her inaction. Further the applicant withheld important information relevant to the determination of her medical impairments as she did not disclose that she was going to counselling as a result of a sexual assault on one of her family members. Further, the respondent argued that the applicant's submissions did not adhere to guidelines provided for in the Tribunal's case conference report and order. Therefore, the application should be dismissed, and it is entitled to costs.

46The respondent has failed to establish that costs are warranted in this matter. First, it failed to explain why the applicant's submissions failed to comply with the Tribunal's case conference report. The Tribunal's case conference report provided that each party's submissions be a maximum of 12 pages. The applicant's submissions were 12 pages in length. Without further explanation it is not obvious how the applicant failed to comply with the Tribunal's case conference report. Further, I do not find the fact that the applicant filed an application disputing her entitlement to accident benefits warrants an award as it is her right to dispute the respondent's denial of accident benefits.

47Regarding the respondent's allegation that the applicant withheld information regarding her psychological status, the Schedule provides the respondent with certain recourse in the event that an insured makes a material misrepresentation regarding an application for accident benefits. This was not an issue before me on this written hearing. Therefore, I do not feel that it would be procedurally fair to the applicant to address it. The threshold to award costs before this Tribunal is a high one.

48The respondent has not established that the applicant acted unreasonably, frivolously, vexatiously or in bad faith during the course of the proceedings. Therefore, the respondent's request for costs is dismissed.

ORDER:

49For all of the above reasons, I order as follows:

i. The applicant is not entitled to payment for the following:

a) a medical benefit in the amount of $5,086.80 for psychological treatment recommended by Nicole McCance Psychology Professional Corporation in a treatment plan (OCF-18) submitted on April 28, 2016 and denied on April 28, 2016;

b) a medical benefit in the amount of $3,014.54 for psychological services recommended by Leanne Wagner Counselling in an OCF-18 submitted on February 3, 2017 and denied on February 8, 2017; and,

c) the balance of $2,200.00 for the cost of a neuropsychological assessment in the amount of $4,400.00 ($2,200.00 approved) recommended by Injury Management and Medical Assessments in an OCF-18 submitted on August 2, 2016 and denied on August 19, 2016.

ii. The applicant is entitled to payment of the following:

a) a medical benefit in the amount of $448.83 ($2,743.37 less $2,294.54 approved) for psychological services recommended by Injury Management and Medical Assessments ("Injury Management") in an OCF-18 submitted on December 15, 2016 and denied on January 12, 2017;

b) a medical benefit in the amount of $2,392.00 for chiropractic services recommended by Multi-Rehabilitation Services in an OCF-18 submitted on September 19, 2017 and denied on September 29, 2017;

c) a medical benefit in the amount of $2,343.00 ($3,593.00 less $1,250.00 approved) for chiropractic services recommended by Multi Rehabilitation Services Inc., in an OCF-18 submitted on February 27, 2017 and denied on March 17, 2017;

d) a medical benefit in the amount of $960.31 ($2,544.89 less $1,584.58 approved) for medication submitted in an OCF-6 on July 22, 2016 and denied on July 26, 2016; and,

e) a medical benefit in the amount of $2,015.21 for medication submitted in an OCF-6 on September 23, 2017 and denied on September 29, 2017.

f) Interest on any overdue payment of benefits pursuant to the Schedule. The applicant is not entitled to interest on issues d) and e).

iii. The respondent is not entitled to costs pursuant to Rule 19.

Released: May 29, 2020

__________________________

Rebecca Hines

Adjudicator

Footnotes

1. 1O. Reg. 34/10.