Licence Appeal Tribunal
Released Date: 09/09/2021
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:
Irene Koufis
Applicant
and
Intact Insurance Company
Respondent
DECISION AND ORDER
ADJUDICATOR: Claudette Leslie
APPEARANCES:
For the Applicant: Tania Lanteigne, counsel for Irene Koufis, Applicant
For the Respondent: Yann Grand-Clement, counsel for Intact Insurance Company
HEARD: In Writing March 9, 2021
OVERVIEW
1The applicant was involved in an automobile accident on April 21, 2017 and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the ''Schedule''). The applicant was denied certain benefits by the respondent and submitted an application for dispute resolution to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”).
2The parties were unable to resolve the issues at a case conference held on October 7, 2020. Consequently, the matter proceeded to a written hearing.
ISSUES
3The following are the issues to be decided:
i. Are the applicant’s injuries predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 limit and in the Minor Injury Guideline (“MIG”)?
ii. Is the applicant entitled to $2,250.29 for physiotherapy services, recommended by Alexmuir Wellness Centre in a treatment plan submitted to the respondent on August 12, 2019?
iii. Is the applicant entitled to $2,714.54 for psychological services, recommended by Alexmuir Wellness Centre in a treatment plan submitted to the respondent on July 26, 2019?
iv. Is the applicant entitled to $2,313.84 for physiotherapy services, recommended by Alexmuir Wellness Centre in a treatment plan submitted to the respondent on February 11, 2019?
v. Is the applicant entitled to $2,768.67 for physiotherapy services, recommended by Alexmuir Wellness Centre in a treatment plan submitted to the respondent on September 5, 2018?
vi. Is the applicant entitled to $3,293.50 for physiotherapy services, recommended by Alexmuir Wellness Centre in a treatment plan submitted to the respondent on April 2, 2018?
vii. Is the applicant entitled to $2,125.00 for a mental health and addictions assessment recommended by Alexmuir Wellness Centre in a treatment plan submitted to the respondent on October 22, 2018?
viii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4Considering all of the relevant evidence provided, l find, on a balance of probabilities that:
a. Because of her pre-accident medical history, the physical injuries sustained in the accident by the applicant fall outside of the MIG treatment limit;
b. The following physiotherapy treatment plans recommended by Alexmuir Wellness Centre are reasonable and necessary, and the applicant is entitled to payment accordingly:
i. in the amount of $2,250.29, submitted August 12, 2019;
ii. in the amount of $2,313.84 submitted February 11, 2019;
iii. in the amount of $2,768.67, submitted September 5, 2018; and
iv. in the amount of $3,293.50, submitted April 2, 2018.
c. The applicant is entitled to interest on any overdue payment amounts of the above.
5The following treatment plans are not reasonable and necessary, and the applicant is not entitled to payment:
a. in the amount of $2,714.54 for psychological services, and
b. in the amount of $2,125.00 for a mental health and addictions assessment.
BACKGROUND
6On the day in question, the applicant had stopped her vehicle in the process of making a left turn when she was rear-ended by the vehicle behind her. She did not lose consciousness, the airbags did not deploy, and she had her vehicle towed to a collision reporting centre, where she left it.
7She was examined by her family physician, Dr. Truscott, a few days later, and was prescribed medication and advised to attend therapy. She reported pain in lower back and right shoulder region and intermittent headaches. She began attending Alexmuir Medical Centre once a week, where she received rehabilitation therapy including electrotherapy, heat, chiropractic sessions, massage therapy ultrasound, and physiotherapy. She indicated that the treatment provided temporary relief.
8The applicant reported having had a few previous accidents, and prior to the accident in question, in January of 2017, she was diagnosed with depression, and was on short term disability leave from her full-time, phone/network company, client representative work. She states that her situation worsened after the accident in question, for example, three months later: she was having sleeping difficulties and tiredness upon waking, loss of appetite, rambling thoughts, and disturbing flashbacks.
THE LAW, EVIDENCE AND ANALYSIS
9Under section 3 of the Schedule,
“a minor injury” means one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae.”
For clarity, the Schedule further defines a “whiplash injury” as an injury to a person’s neck due to sudden acceleration-deceleration force. A “whiplash associated disorder” is defined as a whiplash injury that does not show: “objective, demonstrable, definable and clinically relevant neurological signs…a fracture in or dislocation of the spine.”
10Section 18 of the Schedule states that the sum of medical and rehabilitation benefits payable to an insured person who sustained predominantly minor injuries, is a maximum of $3,500. The provisions also indicate that the $3,500 treatment limit does not apply if the insured person provides compelling evidence that:
a. Their impairment is not predominantly a minor injury because they have an injury/injuries that is/are not simply as a consequence of their soft tissue injuries; or
b. They have a pre-existing condition that prevents them from achieving maximum recovery from the minor injury(ies) under the MIG treatment maximum of $3,500.
Issue (i): Whether the applicant’s injuries are predominantly minor as defined under the Schedule and therefore, subject to $3,500 treatment limit under the MIG
11The burden of proof rests with the applicant to prove, not “beyond a reasonable doubt”, but rather “on a balance of probabilities” that her accident-related injuries are not predominantly minor and therefore, the $3,500 treatment limit does not apply. She argues that not only does her accident-related injuries not meet the minor injury definition, but her pre-accident medical history, both physical and psychological, prevent her from achieving maximum recovery within the MIG limit. The respondent takes the opposite position, despite the fact that according to the applicant, as of November 27, 2019, the respondent has paid $4,453.88 for treatment, which exceeds the MIG limit. The applicant submits the following evidence in support of her position.
12Pre-accident medical evidence: Regarding her pre-accident, physical injuries she points to family doctor Truscott’s Clinical Notes and Records (“CNR”) dating from May 2013, through 2014, 2015, 2016 to December of 2017. Her injuries reported throughout this period include pain in her back, clavicle, right arm, and right shoulder. In February of 2015 an ultrasound of her right shoulder revealed a small sub clavicular spur; and in April of 2016 decrease in bone density in both her lumbar spine and left hip was reported. On October 21, 2015 Dr. Truscott completed a Short-Term Disability (“STD”) form for work, in which he referred the applicant for physiotherapy treatment. Of note, is the fact that throughout this period, the applicant also managed pain with the use of prescribed medication.
13With regards to her pre-accident psychological condition the applicant again points to Dr. Truscott’s CNRs from December 1, 2016 and from January to March 2017. They reveal reported diagnosis of major depression/moderately severe, and that she was unable to work due to depression, inability to concentrate, sleeplessness, and anxiety. In January of 2017 she was again diagnosed with major depression/moderately; and a March 2, 2017 note indicates an independent psychiatry evaluation diagnosis of major depressive disorder “which is recurrent, and is responding partially to current 10psychotropic medication, and Cannabis abuse…”
14On April 11, 2017, Dr. Truscott referred her to the Centre for Addiction and Mental Health’s (“CAMH”) Cognitive Behaviour Therapy Clinic (“CBT”), mainly because of psychological issues linked to work-related problems reported of bullying and being targeted by peers in the workplace. In fact, at the time of the accident she was on short term disability for this reason. The historical notations indicate that in December of 2016 she was unable to work due to among other things, depression, lack of sleep, and that she had undergone mental health counselling.
15Post-accident evidence: The applicant’s post-accident evidence paints the following picture. On April 22, 2017, a day after the accident at Michael Garron Hospital she was diagnosed with mild concussion, headaches, neck pain and a history of depression. On April 25, 2017, Chiropractor, Branko Milen’s disability certificate, indicates the following injuries, and an anticipated recovery period of 9-12 weeks:
Whiplash Associated Disorder (WAD2) including complaints of neck pain with musculoskeletal signs; headaches; chronic post-traumatic headache; superficial injury if [sic] the neck; sprain and strain of cervical spine; superficial injury of the shoulder and upper arm; sprain and strain of lumbar spine ,and of sacroiliac joint; low back pain; nonorganic sleep disorders; and disturbance of activity and attention.
16CNRs reflect, post-accident medical consultations and referrals, on a variety of complaints, including with family doctor, Bruce Truscott. The list starts from April 27, 2017, 2 days post accident up to November 6, 2019, more than two years, after the accident occurred. The records show that she visited the family doctor twice in April of 2017, on the first instance, April 11, she was provided with a letter of referral to CAMH-CBT Clinic; and on the second occasion, due to back pain and whiplash complaints. In May of 2017 she was back twice due to reported injuries of joint, muscle pain, back pain, decreased range of motion. Doctor Truscott prescribed pain medication and acknowledged that sleep medicine expert Dr. Ravinder Mankoo’s report indicates that the applicant had severe sleep apnea and she was prescribed a CPAP machine. A June 26, 2017 consultation with Dr. Lakshmi Ravindran of CAMH notes a diagnosis of severe depression and anxiety. As a result of pain related to the accident, on November 8, 2017 a back assessment was conducted, and the applicant was referred for massage therapy. December 18, 2017 family doctor’s notes indicate that she used cannabis daily to help sleep and for low back pain.
17The CNRs further indicate the following: on April 4, 2018, the applicant’s reported injury is “pain in left leg, left post buttocks; that she had been receiving massage treatment at least once a week since accident; and that Vimovo was prescribed on a trial basis. September 6, 2018 notes indicate that she had been receiving physiotherapy since the Motor Vehicle Accident (“MVA”), and that she has driving anxiety, especially when making a left turn. September 14, 2018 CNRs indicate the applicant complained of ”back pain, lower area and on right”, and that she was using Naproxen for relief; an October 28, 2018 MRI of the lumbar spine revealed…”lumbar spine slight curvature, diffuse disc bulge” and on the following day Naproxen is prescribed. On February 8, 2019 the applicant reported that she is fearful of driving long distances as a result of all of the accidents including those occurring, previously in 2010, 2011, 2013, and later, subsequently in 2019. On November 6, 2019 her complaint is noted as being back pain from the MVA; she was having weekly massages and she experienced “pain in bottom of her back, tender lower SI joint area”. She was provided with a note that she was unable to work for the rest of that week.
18With regards to her psychological health, the applicant points to the following evidence. She met with sleep medicine expert, Dr. Ravinder Mankoo on May 4, 2017, as well, as noted above, on June 26, 2017 with another sleep expert Dr. Lakshmi Ravindran of CAMH. Apart from reported diagnosis of severe depression and anxiety, among other things, Dr. Ravindran found that that the applicant had “decreased sleep onset sleep latency and normal sleep deficiency…severely increased apnea-hypopnea…” To determine the nature and extent of her psychological and emotional, post-accident difficulties, the applicant met with Psychologist, Dr. Leon Steiner. His February 25, 2019 psychological report indicates the applicant reported that as a result of all four accidents she had injured her spine, she was depressed and following the accident in question she had became more anxious, and she experienced flashbacks and intrusive thoughts. The doctor’s diagnosis is, “adjustment disorder with mixed anxiety and depressed mood, specific phobia, situational.” Additionally, Dr. Steiner opines that “her symptoms of avoidance, her anxiety when traveling in a vehicle, including her increased physiological response, her fear of getting into another car accident and suffering bodily injury all suggest the diagnosis of Specific Phobia, Situational.”
The respondent’s position on MIG impairment
19The respondent takes the opposing view for a number of reasons. From a physical perspective the respondent’s conclusion is that the applicant merely sustained mechanical back pain as a result of the accident and her accident related injuries have since healed.
20For example, it points out that on April 27, 2017, 6 days post accident, the applicant reported to the family physician that she was doing well with only a headache; on August 29, 2017, 4 months post accident, she was assessed by Insurer Examination (“IE”) physician, Dr. Ahmed Mian, and diagnosed with a lumbar sprain and soft tissue injury; in the report Dr. Mian indicates, that
the applicant has residual symptoms remaining to her lumbar spine that are soft tissue/myofascial in origin - She displayed some tenderness to her right buttock area while walking. There was mild tenderness when he palpated the paravertebral muscles along L3-L5, just above the right Gluteus’ and that while she had received intensive therapy to date, she has only achieved moderate benefit (as she relayed to me, almost two to three sessions per week, each lasting approximately one hour. This has only provided her with a moderate amount of benefit (40%). I would like to note that she has a history of degenerative disc disease in the lumbar spine region
Notwithstanding, Dr. Mian concluded that her injuries fell under the MIG.
21An IE assessment with Occupational Health Physician Tepperman almost a year and a half later on October 2, 2018, concludes that the applicant’s soft tissue injuries had since resolved. Dr. Tepperman saw no evidence of musculoskeletal or neurological impairment or exacerbation of any pre-existing condition in her low back and concluded that treatment of her accident-related injuries fell under the MIG.
22From a psychological perspective, the respondent also acknowledges that while the applicant had an extensive history of mental health problems, they had nothing to do with the accident. For example, in her June 26, 2017 consultation at CAMH the applicant admitted to a 1986 assault and ongoing bullying at work. There was no mention of the accident as a cause/factor. Similarly, the respondent points out that while the evidence indicates that the applicant began seeing psychologist, Dr. Connie Wong in February of 2017, in September 4, 2018 CNRs, Dr. Wong found that the applicant’s depression and anxiety had been greatly exacerbated by her toxic workplace.
23The respondent relies heavily on IEs it commissioned with clinical Psychologist, Dr. Monique Costa El-Hage. While in a December 11, 2018,assessment, Dr. El-Hage found that the applicant’s “pre-existing issues with mood and anxiety were sufficiently impairing that she was unable to participate in her job”; and although the applicant reportedly experienced some anxiety since accident, especially when making left turns or as a passenger, Dr. El-Hage concluded that the accident did not impact the applicant’s mood. Later in a September 25, 2019 assessment the applicant reported improved emotional and physical condition and improvement in mood since her return to more tolerable workplace and she denied experiencing any significant feelings of sadness or low mood, attributable to the accident in question. Dr. El-Hage also found that the treatment plan proposed by the applicant’s psychologist, Dr. Wong was not reasonable and necessary. Notably, Dr. El-Hage, in the December 2018 assessment, observes that the applicant appeared to be honest and forthright in her information.
24Furthermore, the respondent takes exception to Psychologist, Dr. Steiner’s February 25, 2019 report submitted by the applicant. Its position is that the report lacks credence, because: a) it was performed by Psychometrist Lital Crombie who, in its estimation, is not qualified to conduct the assessment and prepare the report, and the respondent speculates that Dr. Steiner likely played no role supervisory or otherwise, in the assessment; and b) unlike that of IE assessor, Dr. Costa El-Hage, the respondent claims that the applicant’s assessor failed to consider her pre-existing mental condition/medical background as part of their assessment/diagnosis.
25The applicant rebuts the respondent’s claim with regards to Dr. Steiner’s reports. Contrary to the respondent’s position, the applicant points out that at the start of the report, Dr. Steiner states that he was the supervising psychologist, and that psychometrist Crombie performed a part of the assessment. The applicant provided a copy of the Ontario Association of Mental Health Professionals (“OAMHP”) with her reply submissions, which sets out the policies and practices governing mental health professionals, including psychometrists. It clearly indicates that psychometrists are legally permitted to administer and interpret psychological testing, including under the supervision of a psychologist, as is the case here.
26I note here, I am satisfied that the report is both authentic and credible, and as such it deserves maximum consideration. I find no basis for the respondent’s claim that Dr. Steiner likely played no part in the assessment, or that the doctor deliberately compromised his practice in this manner. Furthermore, in my view, Dr. Steiner’s assessment is no less reliable than that of Dr. Costa El Hage’s, the respondent’s IE assessor, given their differing aims: in the applicant’s case the assessment was commissioned to explore her accident related injuries; and in the respondent’s case, to determine whether the applicant’s injuries are predominantly minor/treatable under the MIG limit.
Findings
27The original diagnosis, including as indicated in the post-accident disability certificate, is that the applicant had sustained Whiplash Associated Disorder (WAD2) including “complaints of neck pain with musculoskeletal signs; headaches…superficial injury if [sic] the neck; sprain and strain of cervical spine; superficial injury of the shoulder and upper arm; sprain and strain of lumbar spine, low back pain; nonorganic sleep disorders…” In my view, such injuries are in keeping with the definition of “minor injury” as set out in the Schedule. However, of the two parties involved, I find the applicant provides the more compelling evidence that due specifically to her physical, rather than psychological, pre-accident injuries, she is unable to achieve maximal medical recovery, under the MIG limit, as is the intention of the exception provisions.
28Physical injuries: Starting with the applicant’s pre-accident condition, there is clear evidence that she had pre-existing and recurrent pain complaints including in her lower back, clavicle, and in her right arm and shoulder areas, and that she repeatedly consulted with her physician in search of relief. In February of 2015 an ultrasound of her right shoulder revealed a small sub clavicular spur. Within days of the accident the applicant complained of pain and was diagnosed with among other things, superficial neck shoulder and upper arm injury, cervical and lumbar spine strain/sprain, and low back pain. Following these early days post accident, the evidence shows consistent visits to her physician, and continuing the months following the accident. The applicant’s complaints were consistently: back pain and whiplash complaints of joint, muscle pain, to the point where in November of 2017, seven month’s post-accident, a back assessment was conducted, and she is referred for massage therapy and is reportedly using cannabis to help with among other things her low back pain.
29The applicant’s medical visits post-accident continued into 2018 and 2019. In September of 2018 the applicant reported having been receiving physiotherapy since the accident to relieve her back pain and in the lower area and on the right. An October 2018 MRI revealed she had a slight curvature of the lumbar spine and a “diffuse disc bulge”. In November of 2019, more than two years post-accident, the medical reports/notes indicate that although she has been receiving weekly massages since the accident, she was at that time still experiencing “pain in the bottom of her back, tender lower SI joint area”.
30The only reasonable conclusion I can draw here is that from a physical perspective, a) the applicant had pre-existing complaints in similar areas of her lower and upper back; b) she continued to experience pain in similar areas for an extended period of time/years post accident; c) there is evidence of degeneration in the areas of her lower spine; d) she consistently employs means/medication to ease her pain, albeit temporary; and e) on a balance of probabilities, her pre-existing physical impairments prolonged her recovery/prevented her from recovering from her post-accident injuries within the 6-12 weeks estimated by the chiropractor who completed the disability certificate, for recovery from what appeared to have originally been minor injuries. While the respondent observes that the applicant sustained mechanical back injuries, it does not address the evidence, or the likely reason, that her back pain persisted well beyond the date of the accident and the 12-week period that was recommended for resolving minor injuries.
31Dr. El-Hage, in a December 11, 2018 assessment, observes that the applicant appeared to be honest and forthright in her information. In regards to the applicant’s credibility, I agree with the IE psychologist’s observation and I find no reason to believe, or any indication that the applicant’s medical consultations/treatment were contrived. Clearly, the provisions contemplate that maximum medical recovery may take longer than 12 weeks, and the exceptions from the MIG are intended to accommodate recovery that goes beyond the 12-week period because of pre-existing condition. For the above reasons, in this case, I find the applicant’s physical, accident related injuries fall outside of the MIG treatment limit.
32Psychological injury: At the same time, having determined that the applicant is excluded from the MIG treatment limit due to her physical injuries, I find it unnecessary to elaborate further on her psychological injuries, except as follows:
a. Her pre-accident psychological/sleep issues appeared to have been due mainly to workplace problems.
b. While the indication is that she experienced flashbacks after the accident, was more fearful/anxious of making left turns and driving long distances, there is no clear indication of the extent, or direct connection to accident in question.
c. What the evidence clearly indicates to me is that the applicant has returned to her normal driving activities without hesitation, and she provides no evidence that she requires psychological treatment to achieve maximal medical recovery from any psychological, accident-related injuries she may have sustained in the aftermath.
Issues (ii), (iv), (v), (vi): Whether the treatment plans for physiotherapy services are reasonable and necessary
33Having found that the applicant is outside of the MIG treatment limit because of her pre-existing physical condition in keeping with the provisions of section 15 of the Schedule, to receive payment, the applicant must also prove, on a balance of probabilities, that each of the treatment plans for physiotherapy services recommended by Alexmuir Wellness Centre, is reasonable and necessary.
34While the applicant claims the proposed treatments are reasonable and necessary, the respondent submits that the applicant failed to provide evidence of their reasonableness or necessity. As indicated by its assessors, the respondent maintains that the applicant’s injuries fall within the MIG definition and treatment limit; the injuries she sustained as a result of the accident have since been resolved; and no further treatment is required.
35The applicant’s evidence of the proposed physiotherapy treatment and providers are as follows:
ii. in the amount of $2,250.29, submitted August 12, 2019: for 2 hours of physical and rehabilitation, 1 session of back muscle stimulation, half an hour of therapy of multiple body sites, for a 7-week period;
iv. in the amount of $2,313.84 submitted February 11, 2019: for 2 hours of physical and rehabilitation; 1 session of back muscle stimulation, half an hour of therapy of multiple body sites for an 8-week period;
v. in the amount of $2,768.67, submitted September 5, 2018: for 2 hours of physical and rehabilitation, 1 session of back muscle stimulation, 20 mins of multiple body sites exercise, half an hour of therapy of multiple body sites for a 15-week period;
vi. in the amount of 3,293.50, submitted April 2, 2018: for 2 hours of physical, rehab, 1 session of back muscle stimulation, 40 and 30 mins of multiple body sites exercise, half an hour of therapy of multiple body sites for a duration, unclear to me, of 10 or 15 weeks.
Findings
36Other than outlining the proposed modalities for treatment, the applicant does not indicate the goals of and evaluation mechanisms for each proposed treatment plan. Notwithstanding, evidence of multiple medical consultations regarding common complaints that have persisted long after the accident relating to pain, particularly in and around her lower and upper back/arm areas, supports her assertion that she had yet to achieve maximum medical recovery; in other words, relief from pain. In an IE assessment she reiterated this goal, given she had received pain some relief from the past similar treatment.
Are the treatment plans reasonable and necessary?
37Based on the evidence before me and for the following reasons I find that on a balance of probabilities, they are:
a. Clearly the applicant was still experiencing pain in the same regions of her body up to more than two years post-accident. The most recent evidence of pain complaints is contained in the CNRs of November 6, 2019, in the base/bottom area of her back, and the evidence indicates that at the time of submission of the treatment plans submitted in April and September of 2018 (at one and approximately one and a half years post accident), she was complaining of pain in her leg and buttock; in September it was in her lower back. An October 2018 MRI reveals misalignment/bulge in her lumbar area. In my view, it was not unreasonable that she sought pain relief proposed in the treatment plans (v. and vi.) above.
b. As indicated, the duration of the September treatment would have lasted up to approximately January of 2019. The proposed treatments of the February and August 2019 claims (ii. and iv. above), appear to be equally reasonable and necessary, for on-going, pain relief treatment. As well, the fact that the duration of the latter treatment plans are reduced, in my review reflect a reasonable measure of the effectiveness of the treatment, over time.
38I find the physiotherapy treatment plans proposed, as indicated above are, on a balance of probabilities, realistic for addressing the applicant’s pain complaints and for achieving the goal of maximum medical recovery.
Issues (iii), (vii): Whether the treatment plans for psychological services mental health and additions assessment recommended by Alexmuir Wellness Centre are reasonable and necessary
39The following are the claims at issue:
i. $2,714.54 for psychological services, submitted to the respondent on July 26, 2019; and
ii. $2,125.00 for a mental health and addictions assessment submitted to the respondent on October 22, 2018.
40As indicated above, although the applicant had pre-accident psychological/sleeping issues, they appear to have been workplace related, and had no connection to the accident in question. Reportedly, she experienced some post-accident flashbacks, driving anxiety, and was fearful of driving long distances, not only as a result of the accident in question, but as a result of the multiple accidents in which she had been involved over the years. At the same time, the evidence does not suggest nor indicate that her driving was impeded as a result. Quite notably, is the fact that the applicant readily returned to driving after the accident in question, despite her reported apprehensions with left turns and travelling long distances.
Findings
41From all indications, the applicant returned to her driving activities without psychological difficulties. As previously indicated in this decision, the burden of proof rests with the applicant to prove entitlement to the proposed psychological/mental health treatment. The evidence provided does not lead me to make a finding that she has a need for psychological treatment and mental health and addictions assessment, as a result of the accident. I find the treatment plans proposed are therefore not reasonable or necessary, in this case where the indication is that any accident related psychological impairments have since resolved. There is no evidence that further such treatment or assessments are reasonable and necessary for her psychological/mental recovery.
Issue (viii): Whether the applicant is entitled to interest
42In accordance with section 51 of the Schedule, the applicant is entitled to interest on any overdue, payment amounts incurred for the above, physiotherapy treatment plans (ii, iv, v and vi).
CONCLUSION/ORDER
43While I recognize that the issues determined in this decision may be similar to those contained in the caselaw submitted for consideration by both parties, and the interpretation of the provisions may also be similar, the circumstances, including the mechanics of the accident and the evidence provided, vary in each case. For this reason, in determining the merits of this matter, I have focused my attention primarily on the particulars, facts and the relevant evidence provided, in this case.
44I order that:
a. The applicant’s accident related injuries fall outside of the MIG treatment limit; she is entitled to the following treatment plans; and the respondent shall pay accordingly:
$2,250.29 for physiotherapy services, recommended by Alexmuir Wellness Centre in a treatment plan submitted to the respondent on August 12, 2019;
$2,313.84 for physiotherapy services, recommended by Alexmuir Wellness Centre in a treatment plan submitted to the respondent on February 11, 2019;
$2,768.67 for physiotherapy services, recommended by Alexmuir Wellness Centre in a treatment plan submitted to the respondent on September 5, 2018; and
$3,293.50 for physiotherapy services, recommended by Alexmuir Wellness Centre in a treatment plan submitted to the respondent on April 2, 2018.
b. In keeping with section 51 of the Schedule, the respondent shall pay to the applicant, interest due on any overdue, payment amounts of the above, four, physiotherapy treatment plans.
45The applicant’s claims for the following, are dismissed:
$2,714.54 for psychological services, submitted to the respondent on July 26, 2019; and
$2,125.00 for a mental health and addictions assessment submitted to the respondent on October 22, 2018.
Released: September 9, 2021
Claudette Leslie Adjudicator