Licence Appeal Tribunal File Number: 21-008525/AABS
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:
Rina Conforti
Applicant
and
Aviva General Insurance
Respondent
DECISION
ADJUDICATOR:
Bernard Trottier
APPEARANCES:
For the Applicant:
Joseph Caprara, Counsel
For the Respondent:
Andrea Bandow, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Rina Conforti, the applicant, was involved in an automobile accident on January 8, 2020, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Aviva General Insurance, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute identified in the amended Case Conference Report and Order of June 9, 2023 are:
i. Is the applicant entitled to $1,500.00 ($4,093.30 less $2,593.40 approved) for chiropractic services, proposed by Hydroactive Aquatherapy & Rehabilitation, in a treatment plan/OCF-18 (“plan”) dated February 3, 2021?
ii. Is the applicant entitled to $1,850.00 for a concussion assessment, proposed by Dr. Mahsa Takallou, in a plan dated February 24, 2021?
iii. Is the applicant entitled to $2,257.18 for electromyography (EMG) testing, proposed by Dr. Vincenzo Basile, in a plan dated March 30, 2021?
iv. Is the applicant entitled to psychotherapy sessions at the rate of $149.61 per hour?
v. Is the applicant entitled to $9,917.92 for assistive devices, proposed by Julie Fajertag, in a plan dated November 25, 2020?
vi. Is the applicant entitled to $2,273.72 for a concussion management program, proposed by Dr. Mahsa Takallou, in a plan dated July 30, 2021?
vii. Is the applicant entitled to $3,194.50 for chiropractic services, proposed by Dr. Mahsa Takallou, in a plan dated August 11, 2021?
viii. Is the applicant entitled to $5,074.94 ($8,566.42 less $3,491.48 approved) for physical and mental health therapy, proposed by the Pain and Wellness Centre, in a plan dated January 9, 2022?
ix. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
x. Is the applicant entitled to interest on any overdue payment of benefits?
3On June 14, 2023, with her written submissions, the applicant indicated that the treatment plan described in issue (iii) above was subsequently funded by OHIP when this was referred through a specialist. The applicant withdrew this as an issue in dispute.
4On June 23, 2023, one week after the applicant’s written submissions, the respondent provided correspondence to the applicant, via an Explanation of Benefits letter, that it approved the treatment plans identified as issues (ii), (iii) and (vi) above. The respondent submits that the three approved treatment plans (including the withdrawn issue) are no longer in dispute.
5The hearing will focus primarily on the remaining issues in dispute.
RESULT
6Issues (ii), (iii) and (vi) above are no longer in dispute. The treatment plan proposed in issue (iii) is now funded by OHIP and the applicant withdrew the issue. The respondent agreed to fund the treatment plans proposed in issues (ii) and (vi).
7The applicant has not proven that the disputed treatment plans for physical therapies, namely issues (i), (vii) and (viii) above, are reasonable and necessary as a result of the accident.
8The applicant has not proven that she is entitled to psychotherapy services at a rate of $149.61 per hour (issue iv).
9The applicant has not proven that the treatment plan for assistive devices, as described in issue (v) above, is reasonable and necessary as a result of the accident.
10I find that the delay of the approval for the treatment plans described in issues (ii) and (vi) was unreasonable. An award under s. 10 of Reg 664 (issue ix) is payable for these two treatment plans, together with interest on all amounts then owing.
11Interest (issue x) is payable for issues (ii) and (vi) above, where I find that the approval was delayed unreasonably.
12Since issue (iii) is now funded by OHIP and the applicant withdrew the issue, no interest is payable for this issue.
13Since the treatment plans for issues (i), (iv), (v), (vii) and (viii) are not payable, no interest is payable for these five issues.
PROCEDURAL ISSUE
14The applicant raises a procedural issue that the respondent’s written submissions were not received on June 30, 2023, as required by the amended Case Conference Report and Order (CCRO) dated June 9, 2023.
15The date provided by the Tribunal for the written hearing was July 14, 2023. According to the CCRO, the applicant’s submissions were due 30 days before the written hearing date (June 14, 2023); the respondent’s submissions were due 14 days before the written hearing date (June 30, 2023); and the applicant’s reply submissions were due 7 days before the written hearing date (July 7, 2023). The applicant argues that the respondent’s submissions were not received until July 4, 2023 at 3:37 p.m., and that this late submission provided the applicant with only three days to prepare reply submissions.
16The applicant seeks unspecified costs against the respondent pursuant to s. 17.1 of the Statutory Powers Procedure Act and Rule 19 of the Tribunal’s Common Rules of Practice and Procedure, Version 1 (October 2, 2017), (the “Rules”).
17The applicant’s reply submissions detail the series of events in June and July of 2023 that led to the late submission by the respondent.
i. June 14: Applicant served submissions to respondent’s counsel, Andrea Bandow, and her legal assistant, Joy Browett.
ii. June 30 (between 3:33 and 3:42 p.m.): Ms. Browett sent three separate emails with the respondent’s written submissions and supporting documents. The emails were sent to an incorrect email address, namely that of a different lawyer at the applicant counsel’s firm.
iii. July 4 (1:41 p.m.): Applicant’s counsel, Joseph Caprara, notified the respondent via email that they had not received the respondent’s submissions.
iv. July 4 (3:37 p.m.): Respondent’s counsel, Ms. Bandow, sent her written submissions and supporting documents to Mr. Caprara.
18The applicant’s counsel argues that that the respondent’s counsel and her assistant were neglectful in their failure to recognize the incorrect email address, since the parties had been in ongoing email communications leading up to the hearing. The applicant’s counsel argues that they incurred additional costs by having only three days to provide reply submissions instead of the seven days indicated in the CCRO.
19I recognize that the respondent made an error in providing its submissions to an incorrect email address, in this case to another lawyer at the same firm. Rule 19 allows the Tribunal to award costs where it believes a party has acted unreasonably, frivolously, vexatiously or in bad faith. Based on the evidence before me, I do not believe that the respondent behaved in this manner. When notified of its error, the respondent promptly sent its submissions to the applicant. I do not have evidence before me that the applicant incurred additional costs in preparing reply submissions in three days instead of the usual seven. I note as well that the applicant’s colleague could have notified counsels for both the respondent and the applicant of the error, to make an earlier correction.
20For the reasons above, I decline to award costs for the respondent’s late submissions.
ANALYSIS
Further passive physical therapies, beyond those already approved, are not reasonable and necessary
21I find the evidence does not support, on the balance of probabilities, that the disputed treatment plans, described in paragraphs 2(i), 2(vii) and 2(viii) above, would provide musculoskeletal and functional recovery from the applicant’s accident-related injuries at the time they were proposed.
22To receive payment for a treatment and assessment plan under s. 15 and 16 of the Schedule, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
23On February 3, 2021, approximately 13 months post-accident, Dr. Mahsa Takallou, chiropractor, submitted a treatment and assessment plan (“OCF-18”) that proposed chiropractic treatment, shockwave therapy and a thumper massager. The respondent partially approved the treatment plan for chiropractic services ($2,593.40) but denied the line items for shockwave therapy ($1,200) and the thumper massager ($300).
24On August 11, 2021, Dr. Takallou submitted an additional OCF-18 for chiropractic services in the amount of $3,194.50. The respondent fully denied this treatment plan, indicating it did not find the proposed treatment reasonable and necessary.
25On January 9, 2022, the Pain and Wellness Centre (PWC) submitted an OCF-18 for an interdisciplinary pain management program consisting of psychological, chiropractic, naturopathic and massage therapy services, in the amount of $8,566.42. The respondent partially approved the treatment plan in the amount of $3,491.48 for psychological services and associated planning, documentation and support activities (lines 3, 5, 6 and 7 on the OCF-18) and denied $5,074.94 for chiropractic and massage therapy services (lines 1, 2 and 8) and for naturopathic services (line 4).
26The applicant submits that she suffered from radiculopathy (pinched nerves), myelopathy (spine compression) and neuropathy (nerve damage) as a result of the accident, necessitating the proposed shockwave treatments and thumper massager. In support of this position, the applicant points to the clinical notes and records (CNRs) of the applicant’s family physician, Dr. Renee Lewi, who noted radicular pain in consultations with the applicant on July 5, 15 and 22, 2021.
27The applicant also submits that her physical impairments are documented by Dr. Vincenzo Basile, neurologist (January 22, 2021), Dr. Angela Mailis, pain specialist with PWC (April 28, 2022 and February 9, 2023), Chelsea Duncan, massage therapist at PWC (May 6 and August 5, 2022), Dr. Naomi Kupferstein, chiropractor at PWC (July 14, 2022) and Dr. Neilank Jha, neurosurgeon (April 5, 2023).
28The applicant further submits that despite the respondent’s denials of the proposed physical therapy treatment plans, she continued to participate in massage therapy, chiropractic treatment, aquatherapy and osteopathic services, funded partly through the applicant’s extended health care (EHC) plan, with the applicant paying for any unfunded balances out-of-pocket.
29The applicant notes that an OCF-18 for physiotherapy, in the amount of $2,155.00 was submitted on April 12, 2023 and approved by the respondent in full on May 5, 2023. This treatment plan is not in dispute. The applicant notes that despite the respondent’s position that further facility-based treatment is not reasonable and necessary for the applicant to recover from her accident-related injuries, the respondent approved this OCF-18 but has not reconsidered approval of the previously denied physical therapy treatment plans.
30In her reply submissions, the applicant argues that her radiculopathy, neuropathy and chronic pain are a direct result of the accident and that causation is not an issue in this matter since these complaints were not present before the accident.
31The respondent submits that the applicant had musculoskeletal conditions, including osteopenia, scoliosis, degenerative disc disease and arthritis, that pre-date the subject accident. On the date of the accident, the applicant was 52 years old and had been diagnosed with “significant” scoliosis and degenerative disc disease in her thoracic and lumbar spines as early as 2010.
32The respondent also submits that x-rays taken on the date of the accident revealed degenerative changes characterized by disc space narrowing with endplate osteophyte formation in the applicant’s cervical, thoracic and lumbar spines, as well as right scoliosis of the thoracolumbar junction. Specifically, the x-ray report stated that there was “no convincing superimposed acute traumatic injury identified” in the applicant’s cervical, thoracic and lumbar spines on that date.
33The respondent submits that they are required under the Schedule to pay only for medical and rehabilitation expenses that are reasonable and necessary as a result of the subject accident. The respondent submits that the applicant’s predominant pain following the accident was related to her pre-existing degenerative changes, including diagnoses of scoliosis and osteopenia, as opposed to the soft-tissue injuries sustained in the accident.
34Regarding the OCF-18 submitted on February 3, 2021, the respondent submits that they approved the line items for chiropractic services but denied the line item for shockwave therapy since they could find no corroborating evidence from Dr. Lewi or other OHIP-funded specialists that the applicant would receive meaningful medical benefit in treating her accident-related injuries using shockwave therapy. The respondent relies on the insurer’s examinations (IEs) of Dr. Michael Hanna, general practitioner, who performed an in-person assessment of the applicant on January 27, 2021, more than a year post-accident, as well as a paper review assessment on February 26, 2021. Based on these assessments, Dr. Hanna opined at that time that “further passive modalities are unlikely to provide further benefit at this juncture.” Dr. Hanna also opined, in reviewing the OCF-18, that he could not find any specific comments from Dr. Takallou on how shockwave therapy would assist in achieving the goals of the plan to a reasonable degree.
35The respondent also denied the line item for a thumper massager. The respondent relies on the additional comments section of the OCF-18 that proposes manual therapy “delivered with the hands as opposed to a device or machine” and could find no explanation as to why the thumper massager is necessary in addition to the proposed (and approved) chiropractic therapy.
36Regarding the treatment plan for chiropractic services submitted August 11, 2021, the respondent relies on the previous IEs of Dr. Hanna, as well as a third IE performed by Dr. Hanna on November 4, 2021. In this latest IE report, Dr. Hanna indicates that the applicant reported that despite receiving chiropractic treatment, almost two years post-accident, she had improved only 30 to 40%. Dr. Hanna opined that further facility-based rehabilitation was unlikely to provide any long-term benefits from the applicant’s accident-related injuries.
37The respondent also relies upon the MRI report of the applicant’s cervical spine, taken on August 15, 2021, that confirmed multilevel degenerative changes as well as the CNRs of Dr. Lewi, from August 19, 2021, that diagnosed the applicant with cervical spine degenerative disease.
38Regarding the treatment plan for the interdisciplinary pain management program, submitted January 9, 2022, the respondent relies again on the previous IEs of Dr. Hanna as well an updated paper-review assessment by Dr. Hanna, in a report dated February 3, 2022. Dr. Hanna opined that the psychological services proposed in this plan are reasonable and necessary but that the facility-based physical rehabilitation portions of the OCF-18, based on passive modalities more than two years post-accident, are not. The respondent also indicates that they could not find any corroborating evidence from Dr. Lewi, or other practitioners outside of PWC, that naturopathic treatment would provide benefit for the applicant’s accident-related injuries.
39The respondent also relies upon imaging of the applicant’s cervical spine, from June 23, 2022, that continued to reveal degenerative changes including multilevel facet arthropathy, as well as imaging, from November, 2022, that revealed right convex lumbar scoliosis with superimposed spondylotic (age-related) changes.
40Contrary to the applicant’s assertion that causation is not in dispute in this matter, the respondent argues that the applicant’s primary source of pain is degenerative disc disease that predates the accident and not due to the soft-tissue injuries sustained in the accident.
41In reviewing the submissions and the evidence before me, I am persuaded by the respondent’s arguments that further facility-based passive treatments, including chiropractic and massage therapy services, would not provide any further benefits for the applicant’s accident-related injuries. The applicant herself indicated that the chiropractic treatment she was receiving, both through the respondent as well as through the applicant’s EHC plan, made her “only slightly better physically” as reported to Dr. Levi in April of 2022.
42The respondent’s IE assessor, Dr. Hanna, has been consistent in his opinion that active rehabilitation, including exercise and physiotherapy, would be a preferred form of treatment when the above OCF-18s were submitted, more than one and two years post-accident. Dr. Hanna’s opinion is based on his two in-person assessments of the applicant as well as three paper reviews of the applicant’s extensive medical records. In keeping with that opinion, the respondent approved the proposed treatment plan for physiotherapy on April 12, 2023. I find Dr. Hanna’s opinion persuasive since it is consistent with the weight of the medical evidence before me.
43The burden of proof rests with the applicant to demonstrate that the three proposed treatment plans for passive physical therapies are reasonable and necessary to provide musculoskeletal and functional recovery from the applicant’s accident-related injuries. I find that this burden has not been met. The proposed treatment plans are not reasonable and necessary since (a) the goals of rehabilitation are not being met by further treatment and (b) the cost of achieving these goals through the proposed treatment plans is unreasonable compared to other medical alternatives.
The applicant is not entitled to psychotherapy services at $149.61 per hour
44I find that the rate of $99.75 per hour paid by the respondent for psychotherapy services, provided by Ms. Vera Sukhoveyeva, registered psychotherapist, complies with the Schedule and the Professional Services Guideline (the “Guideline”). The rate of $149.61 per hour proposed by the applicant is not.
45On March 1, 2021, the respondent approved psychotherapy services at a rate of $99.75 per hour following a review of the curriculum vitae of Ms. Sukhoveyeva. Prior to this approval, Ms. Sukhoveyeva’s clinic, Hydroactive Aquatherapy & Rehabilitation (“Hydroactive”), submitted Auto Insurance Standard Invoices (OCF-21s) on January 5, 2021 and February 1, 2021, billing psychotherapy sessions at an hourly rate of $149.61.
46The applicant submits that a treating psychotherapist is entitled to be paid at the same hourly rate as a psychologist or psychological associate under the Guideline for cognitive behavioural therapy, citing J.V. v. Intact Insurance Company (2019 CanLII 130366 ON LAT).
47Hydroactive’s psychologist, Dr. Peter Waxer, submitted an OCF-18 for psychological services on September 9, 2020. In its approval dated September 15, 2020, the respondent agreed to pay an hourly rate $149.61 per hour for a registered psychologist and $58.19 per hour for a psychotherapist, noting that the psychotherapist could call the adjuster to discuss the rate.
48The CNRs from Hydroactive indicate that the psychotherapy treatment was started on November 10, 2020 and that Ms. Sukhoveyeva was the treating psychotherapist. The respondent spoke to a representative of Hydroactive and, after reviewing Ms Sukhoveyeva’s credentials, the two parties agreed to an hourly rate of $99.75.
49The respondent submits that psychotherapists are not listed specifically in the Guideline. Accordingly, the Guideline indicates that the rates for services not covered by the Guideline are to be determined by the parties involved. Subsequently, on July 5, 2021, Hydroactive submitted an OCF-21 with the rate sought for Ms. Sukhoveyeva’s services of $99.75, indicating that Hydroactive had accepted this rate.
50In her reply submissions, the applicant argues that the applicant incurred the difference in provider rates “under protection of account” and that the difference is owed to Hydroactive in the amount of $667.61.
51I am persuaded by the respondent’s argument that the rate for psychotherapists is not covered specifically in the Guideline, and that the Guideline is clear that the rate is to be determined by the parties involved. Hydroactive’s acceptance of that rate, as evidenced by its subsequent invoices, indicates that the parties had come to an agreement.
52Based on the evidence before me, I find that the applicant has not met the burden of proof that she is entitled to receive psychotherapy services at a rate of $149.61 per hour.
A new bed and mattress system is not reasonable and necessary to treat the applicant’s accident-related injuries
53I find that the applicant has not met her burden in proving that the treatment plan totalling $9,917.92, for a king-sized mattress, adjustable base, supportive pillow, mattress protector, taxes, delivery, setup and warranty is reasonable and necessary as a result of the accident.
54As with the previous physical therapy treatment plans, the applicant bears the burden of demonstrating on a balance of probabilities that the benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
55On November 25, 2020, Ms. Julie Fajertag, occupational therapist, submitted an OCF-18 for the above assistive devices based on an in-home functional assessment report dated July 13, 2020. The stated goals of the treatment plan are to facilitate the initiation and maintenance of sleep as the applicant continues to experience difficulty in obtaining restful sleep following the accident. In Ms. Fajertag’s report, she indicated that the applicant awakens multiple times throughout the night from pain and discomfort, which leads to fatigue throughout the day.
56The applicant submits that pre-accident, she did not have any concerns with the quality of her sleep. In support of the applicant’s position, the applicant pointed to numerous notes in the CNRs of Dr. Lewi, who documents ongoing complaints of poor sleep because of pain. The reports of poor sleep with Dr. Lewi are consistent with those in the CNRs of Hydroactive and PWC. As a result of the applicant’s ongoing sleep complaints, Dr. Lewi referred the applicant to Dr. Laura Goode, a respiratory and sleep medicine specialist.
57The respondent submits that the applicant’s difficulty with sleep is not primarily as a result of the accident. In a diagnostic sleep study conducted by Dr. Goode, on August 4, 2021, Dr. Goode indicated that the applicant has severe obstructive sleep apnea associated with mild oxygen desaturation, to a nadir of 85%, and that her sleep is fragmented by respiratory arousals. In her assessment, Dr. Goode recommended weight loss and a continuous positive airway pressure (CPAP) machine as the primary first-line therapies to address the applicant’s symptoms. Dr. Goode’s report to Dr. Lewi, dated September 17, 2021, does not recommend a new bed system.
58The respondent also relies upon the IEs of Dr. Hanna who opines that the applicant’s predominant pain following the accident was related to pre-existing degenerative changes to her cervical, thoracic and lumbar spine. Dr. Hanna is silent with respect to the applicant’s respiratory and sleep apnea diagnoses.
59I find the report of Dr. Goode persuasive since it is the only formal testing of sleep symptoms before me. In her reply submissions, the applicant argues that Dr. Goode’s diagnosis of sleep apnea does not negate the applicant’s other sleep complaints related to accident-related pain. I find Dr. Goode’s recommendation to pursue the first-line therapies of weight loss and a CPAP machine has weight, given her expertise.
60Based on the balance of probabilities, I find that the applicant has not met the burden of proof that she is entitled to receive a new bed and mattress system, as described in the proposed treatment plan, as a result of the accident.
An award is payable
61The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable together with interest on all amounts then owing to the applicant (including unpaid interest) at a rate of 2% per month, compounded monthly, if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
62The applicant submits that she provided the respondent with ample medical evidence in support of her claims for the following three treatment plans that were approved by the respondent on June 23, 2023, one week after the applicant provided her written submissions.
i. A concussion assessment, proposed by Dr. Takallou in the amount of $1,850, in a treatment plan dated February 24, 2021;
ii. Electromyography (EMG) testing, in the amount of $2,257.18, proposed by Dr. Basile in a treatment plan dated March 30, 2021;
iii. A concussion management program, in the amount of $2,273.72, proposed by Dr. Takallou in a treatment plan dated July 30, 2021?
63The approval of these three treatment plans after the applicant’s written submission suggests that the respondent was persuaded by the applicant’s arguments and a re-evaluation of the medical evidence. There was no new evidence since all the relevant evidence had been previously produced well ahead of the written hearing date.
64I note that the EMG testing proposed above was subsequently funded by OHIP after a referral from a specialist. I do not find that the respondent acted unreasonably in delaying approval of this treatment plan since the applicant could have taken measures to obtain an OHIP-funded referral sooner.
65The applicant submits that the respondent had information from their own neurology assessor, Dr. Konstantine Zakzanis, who opined, in his IE report of November 25, 2021, that the applicant suffered a mild traumatic brain injury (a concussion) as a result of the accident.
66I recognize that the respondent had a previous neurological assessment (from May 7, 2021) conducted by Dr. Barbara Connolly, neurologist, that indicated that the applicant had not likely suffered from a concussion and that the treatment plan for a concussion assessment was not reasonable and necessary. It is possible for different medical specialists assessing the same patient to arrive at different conclusions.
67I find that the respondent acted unreasonably in delaying the approval of the concussion assessment and concussion management program. Upon receipt of the later neurological assessment, the respondent could have exercised caution and could have approved these treatments much sooner than it did. The harm to the applicant was the delay in obtaining treatment for her concussion injuries. The respondent’s eventual approval of the concussion-related treatment plans indicates it agrees with the weight of the medical evidence that the applicant suffered a concussion.
68For the reasons above, I find that the applicant is entitled to an award of 25% of the disputed amount of the treatment plans for a concussion assessment and a concussion management program, together with interest on all amounts then owing to the applicant (including unpaid interest) at a rate of 2% per month, compounded monthly, from the date of the second neurological IE report, namely November 25, 2021.
69For the other treatment plans in dispute, I have found that no benefits are payable. I do not find that the respondent unreasonably withheld or delayed payment for these benefits. As a result, an award under s. 10 of Reg. 664 is not warranted for these other treatment plans.
Interest is payable for two concussion-related treatment plans
70The Tribunal may award benefits and interest to which an insured person is entitled under the Schedule. Interest is payable on all amounts then owing to the insured (including unpaid interest) at the rate of 2 per cent per month, compounded monthly, from the time the benefits first became payable under the Schedule.
71The respondent accepted that the concussion assessment and concussion management program, previously denied, were payable under the Schedule. The respondent agreed to fund these two treatment plans on June 23, 2023. The applicant is entitled to interest at a rate of 2% per month, compounded monthly from November 25, 2021 to June 23, 2023, on the amounts then owing.
Interest is not payable for the other treatment plans
72Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Since no benefits are payable for the other treatment plans in dispute (i.e., other than the concussion assessment and the concussion management program), no interest is payable for these plans.
ORDER
73The applicant has not demonstrated that she is entitled to the disputed amounts for the treatment plans for chiropractic and physical therapy services as described in paragraphs 2(i), 2(vii) and 2(viii) above, since they are not reasonable and necessary to treat the applicant’s accident-related injuries.
74The applicant has not demonstrated that she is entitled to receive psychotherapy services at an hourly rate of $149.61.
75The applicant has not demonstrated that the proposed treatment plan for a new bed and mattress system is reasonable and necessary to treat the applicant’s accident-related injuries. As a result, she is not entitled to this medical and rehabilitation benefit.
76The applicant is entitled to an award of 25% of the amount in dispute for the proposed treatment plans for a concussion assessment and a concussion management program. The amount of this award is $1,030.93, together with interest on all amounts then owing to the applicant (including unpaid interest) at a rate of 2% per month, compounded monthly, from the date of the second neurological IE report, namely November 25, 2021.
77The applicant is entitled to interest at a rate of 2% per month, compounded monthly from November 25, 2021 to June 23, 2023, on the amounts then owing for the concussion assessment and the concussion management program.
78Since no treatment plans other than the concussion assessment and concussion management program are payable, no interest is payable for these other treatment plans.
Released: October 16, 2023
Bernard Trottier
Adjudicator