Licence Appeal Tribunal File Number: 21-007739/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:
Minh Tho Ho
Applicant
And
Aviva Insurance Company
Respondent
DECISION
ADJUDICATOR:
Nick Iannazzo
APPEARANCES:
For the Applicant:
Jessie Tran, Paralegal
For the Respondent:
Joanne R. Witt, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Minh Tho Ho, the applicant, was involved in an automobile accident on April 26, 2019, 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 Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2In 1998, the applicant was involved in an altercation where he sustained a head injury requiring 25 sutures to the back of his head.
3Since April 2014, Dr. Albert Allen, Psychiatrist, has been treating the applicant for Persistent Depressive Disorder in partial remission, post-traumatic stress disorder, and chronic headaches.
4On April 26, 2019 the applicant was involved in a motor vehicle accident. The applicant was injured and taken to the North York General Hospital. He reported head pain, neck pain, back pain, and numbness in his right arm.
5The applicant applied for accident benefits from the respondent.
6On May 9, 2019 the applicant commenced physiotherapy at Pain Rehabilitation Clinic.
7On January 16, 2020, the applicant was assessed by Dr. Susan Mackenzie, Psychiatrist, pursuant to section 44 of the Schedule, that resulted in a report dated February 13, 2020. Dr. Mackenzie opined that the applicant “has suffered specific phobia, vehicular, as well as an exacerbation of depressive symptoms, related to a pre-existing diagnosis of major depressive disorder, as a result of the subject MVA”.
8On March 4, 2020, based upon the opinion of Dr. Mackenzie, Psychiatrist, the applicant was removed from the Minor Injury Guideline.
9The respondent denied several treatment plans and partially approved two plans that are the subject matter of this application.
ISSUES
10The applicant had filed two applications with the Tribunal, one on June 22, 2021 and the other on January 4, 2023. The respondent filed a motion to consolidate the two applications which was heard on April 11, 2023. An order was made consolidating the two applications and ordering that it proceed by way of a written hearing.
11The applicant, in his submissions, withdrew the issue pertaining to a social work assessment in the amount of $2,800.00 dated February 19, 2020.
12The remaining issues in dispute are:
i. Is the applicant entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated March 18, 2020?
ii. Is the applicant entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated July 15, 2020?
iii. Is the applicant entitled to $8,600.00 for physiotherapy services (chronic pain program), proposed by Pain Rehabilitation Clinic in a treatment plan dated August 27, 2020?
iv. Is the applicant entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated October 6, 2020?
v. Is the applicant entitled to $1,025.00 for a TENS unit, proposed by Pain Rehabilitation Clinic in a treatment plan dated March 18, 2020?
vi. Is the applicant entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated January 6, 2021?
vii. Is the applicant entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated April 28, 2021?
viii. Is the applicant entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated July 28, 2021?
ix. Is the applicant entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated October 27, 2021?
x. Is the applicant entitled to $2,200.00 for a General Physical Assessment, proposed by Pain Rehabilitation Clinic in a treatment plan dated February 8, 2022?
xi. Is the applicant entitled to $2,200.00 for a Psychiatric Assessment, proposed by Pain Rehabilitation Clinic in a treatment plan dated March 23, 2021?
xii. Is the applicant entitled to $379.69 ($2,200.00 less $1,820.31 approved) for a Psychological Assessment, proposed by Disability Medicine Specialists in a treatment plan dated August 10, 2020?
xiii. Is the applicant entitled to $893.04 ($3,990.50 less $3,097.46 approved) for a Psychological Counselling, proposed by Disability Medicine Specialists in a treatment plan dated January 19, 2021?
xiv. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
xv. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
13I find that the applicant is entitled to:
i. $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated March 18, 2020, and interest pursuant to s. 51 of the Schedule;
ii. $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated July 15, 2020, and interest pursuant to s. 51 of the Schedule;
iii. $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated October 6, 2020, and interest pursuant to s. 51 of the Schedule;
iv. $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated January 6, 2021, and interest pursuant to s. 51 of the Schedule; and
v. $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated April 28, 2021, and interest pursuant to s. 51 of the Schedule.
14I find that the applicant is not entitled to any other treatment plans in dispute.
15I find that the applicant is not entitled to an award.
PROCEDURAL ISSUES
mISSING dOCUMENTS
16After reviewing the parties’ written submissions and evidence, the following documents were not filed with the Tribunal, despite being referred to by the parties in their submissions:
Treatment plan (OCF-18) in the amount of $1,025.00 for a TENS unit, proposed by Pain Rehabilitation Clinic, dated March 18, 2020; and
Treatment plan (OCF-18) in the amount of $2,200.00 for a Psychiatric Assessment, proposed by Pain Rehabilitation Clinic, dated March 23, 2021.
I requested that the applicant file a copy of the above documents by September 20, 2024, and the applicant did so via email on September 16, 2024.
Motion to strike
17On December 5, 2023, three days before the Hearing Date on December 8, 2023, the respondent filed a sur-reply, which it refers to as “Reply Submissions”. On December 7, 2023 the applicant filed a Notice of Motion to strike the respondent’s sur-reply and/or in the alternative, award costs against the respondent under Rule 19.1, and such further and other relief as the Tribunal may order.
18On December 9, 2023 the respondent filed submissions in response to the applicant’s Notice of Motion and sought leave to file a sur-reply pursuant to Rules 3.1 and 3.2 of the Licence Appeal Tribunal Rules, 2023 (“Rules”) and such further and other relief as the Tribunal may order.
19The applicant submits that the respondent did not have the right to file a sur-reply. The Motion Order dated April 12, 2023 provided for the applicant’s submissions and evidence, the respondent’s submissions and evidence, and the applicant’s reply. There was no order permitting the respondent to file a sur-reply, and the respondent did not seek leave of the Tribunal to file a sur-reply. Furthermore, the applicant submits that the respondent has not led any evidence that new issues were raised in the applicant’s reply supporting the argument that it should be permitted to file a sur-reply.
20The respondent submits that after reviewing the applicant’s reply submissions it noted that decided principles from the case law needed to be submitted. It submits that it provided five decisions of the Tribunal because the applicant failed to consider these established principles arising from the case law. It submits that case law and prior decisions of the Tribunal on an issue in dispute are not evidence, argument or documents.
21The respondent submits that its failure to request leave to file a sur-reply was done through inadvertence. In any event, the respondent submits that the information in the sur-reply was known and available to the applicant and therefore is not prejudiced by the Tribunal granting leave to file a sur-reply. Lastly, it submits that an adjudicator has an obligation to consider all applicable case law.
22I agree with the applicant’s submissions. I deny the respondent’s motion to file a sur-reply and strike the respondent’s sur-reply, for the reasons that follow.
23Firstly, the Motion Order dated April 12, 2023 does not grant the respondent permission to file a sur-reply and it is unreasonable to suggest that failure to prohibit the respondent’s sur-reply means it is permitted.
24Secondly, the respondent did not comply with the Rules and bring a motion to seek leave to file a sur-reply prior to it submitting its sur-reply.
25Thirdly, permission to file a sur-reply will only be granted in exceptional circumstances. They are not an opportunity for a party to bolster their previous submissions. They may be necessary when a party has made new legal arguments or introduced additional issues in reply, provided an inaccurate statement of the law, or an inaccurate statement of facts critical to the determination of the issues in dispute. I find that the facts in this matter do not warrant a sur-reply. The respondent has not directed me to where in the applicant’s reply he raised a new legal argument, introduced additional issues, or provided an inaccurate statement of the law or facts critical to the determination of the issues before me. Furthermore, I do not see why the respondent could not have raised the five Tribunal decisions in their submissions. And, in any event, I am not bound by other Tribunal decisions.
26Accordingly, I deny the respondent’s motion to file a sur-reply, and I strike the respondent’s sur-reply.
27I do not find any behaviour on the part of the respondent that reaches the high threshold for ordering costs under Rule 19. Although the respondent did not bring a motion prior to filing its sur-reply, I do not find that that conduct rises to the level of being unreasonable, frivolous, vexatious or in bad faith.
ANALYSIS
Are the treatment and assessment plans reasonable and necessary?
28To 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. Factors to consider are the identified goals of treatment, how the goals would be met to a reasonable degree, and that the overall cost of achieving them are reasonable.
29I considered all the submissions and case law submitted by the parties, although I do not refer to every submission or case in my decision.
The applicant is entitled to the treatment plans dated March 18, July 15, and October 6, 2020 and January 26, 2021, each in the amount of $2,600.64.
30The treatment plans dated March 18, 2020, July 15, 2020, October 6, 2020 and January 26, 2021 each in the amount of $2,600.64, were completed by Pain Rehabilitation Clinic (“PRC”) and they each proposed physiotherapy.
31The proposed goals of each treatment plan are pain reduction, increase in strength and increased range of motion. The stated functional goals are returning to activities of normal living, modified work activities, and pre-accident work activities. Barriers to recovery were identified as psycho-social impairments.
32The applicant submits that the treatment plans are reasonable and necessary despite the treatments providing temporary relief of pain. He relies upon the evidence from the applicant’s psychiatrist, Dr. Allen, and the applicant’s physiotherapy records. The applicant also submits that the respondent’s denials were vague and no medical reasons were given, and that the denials amounted to deficient notices, contrary to section 38(8) of the Schedule, and therefore the respondent is liable to pay for the services in the treatment plans per section 38(11)2.
33The respondent submits that it complied with section 38(8) when denying the applicant’s benefits. It further submits that the applicant’s physical impairments directly from the subject accident are predominantly minor and do not require ongoing treatment. The respondent relies upon the report of Dr. Alan Kruger, General Practitioner, dated February 13, 2020, and the report of Dr. Shafik Dharamshi, General Practitioner, dated June 4, 2021.
34For the reasons that follow, I find that the applicant has proven on a balance of probabilities that the treatment plans are reasonable and necessary.
35Firstly, I find that the applicant consistently reported pain to his head, neck and back, and numbness in his right arm. After the subject accident on April 26, 2019, the applicant was transported to North York General Hospital, and he reported the immediate onset of pain to his head, neck and back, and numbness in his right arm. Shortly after the accident, the applicant commenced attending physiotherapy treatments at the PRC. PRC’s notes from May 15, 22, 29, June 5, July 10, 24, November 27, 2019 state that the applicant reported headaches, pain in the neck, shoulder and back, and numbness in the right arm.
36Secondly, the applicant’s treating psychiatrist, Dr. Allen, recommended that he continue with rehabilitation to treat the pain issues. In a letter dated January 20, 2020 to Dr. Bui, Chiropractor, of PRC, Dr. Allen confirmed that he had been treating the applicant for Persistent Depressive Disorder in partial remission, PTSD, and chronic headaches since April 2014. He noted that since the motor vehicle accident the applicant was experiencing worsening psychiatric symptoms. He stated that from his perspective “… the treatment of these psychiatric comorbidities after the accident is really to continue the same medication he is taking already (nortritypline, Biphentin and risperidone), and to give himself time, as well as rehabilitation to treat the pain issues.” Since Dr. Allen has been treating the applicant since 2014, I find his recommendation that rehabilitation continue persuasive.
37Thirdly, I am not persuaded by the respondent’s submission that based upon Dr. Kruger’s report dated February 13, 2020 the treatment plans are not reasonable and necessary. This report was not prepared for the purposes of assessing the treatment plans in dispute, but instead to assess the applicability of the minor injury guideline, non-earner benefits, and two treatment plans dated July 24 and November 27, 2019 that were partially approved by the respondent. Although Dr. Kruger opined that the physical impairments directly from the subject accident are predominantly minor and do not require ongoing treatment, he does report that the applicant had pain when performing range of motion and strength testing, and the applicant reported pain at the end ranges of all exercises. As noted earlier, Dr. Allen had been treating the applicant since 2014 and recommended rehabilitation to treat the applicant’s pain issues. I prefer Dr. Allen’s evidence and recommendation over that of Dr. Kruger who met the applicant once and for only about one hour.
38Fourthly, Dr. Dharamshi’s report dated June 4, 2021 was prepared a considerable time after the date of these treatment plans (i.e. March 18, 2020; July 15, 2020; Oct. 6, 2020; Jan. 6, 2021), and accordingly he would not have known the applicant’s condition at the time of the plans. For this reason, I place little weight on this report.
39Since I find that the applicant has proven on a balance of probabilities that the treatment plans are reasonable and necessary, it is not necessary to address the applicant’s section 38(8) submissions.
The applicant is entitled to the treatment plan dated April 28, 2021 in the amount of $2,600.64.
40The treatment plan dated April 28, 2021 in the amount of $2,600.64 was completed by PRC and proposed physiotherapy.
41The proposed goals of the treatment plan are pain reduction, increase in strength and increased range of motion. The stated functional goals are returning to activities of normal living, modified work activities, and pre-accident work activities. Barriers to recovery were identified as psycho-social impairments.
42The applicant submits that the treatment plan is reasonable and necessary despite the treatment providing temporary relief of pain. He relies upon evidence from the applicant’s psychiatrist, Dr. Allen, and the applicant’s physiotherapy records. The applicant also submits that the respondent’s denials were vague and no medical reasons were given, and that the denials amounted to deficient notices, contrary to section 38(8) of the Schedule, and therefore the respondent is liable to pay for the services in the treatment plans per section 38(11)2.
43The respondent submits that it complied with section 38(8) when denying the applicant’s benefits. It further submits that the applicant’s physical impairments directly from the subject accident are predominantly minor and do not require ongoing treatment. The respondent relies upon Dr. Alan Kruger’s report dated February 13, 2020 and Dr. Shafik Dharamshi’s report dated June 4, 2021 where they respectively opined that the applicant’s physical injuries are minor.
44For the reasons that follow, I find that the respondent’s denial of the treatment plan failed to satisfy section 38(8).
45Sections 38(8) and 38(11) of the Schedule set out strict notice requirements for insurers responding to treatment plans and specific consequences if they fail to comply. Section 38(8) requires an insurer to inform an insured person of the medical and other reasons why it considered the goods and services not to be reasonable and necessary if it denies a treatment plan. The requirement of medical reasons was explained in the reconsideration decision of T.F. v. Peel Mutual Insurance Company 2018 CanLII 39373 (ON LAT), in which the Executive Chair stated:
an insurer’s “medical and any other reasons” should, at the very least, include specific details about the insured’s condition forming the basis for the insurer’s decision or, alternatively, identify information about the insured’s condition that the insurer does not have but requires. Additionally, an insurer should also refer to the specific benefit or determination at issue, along with any section of the Schedule upon which it relies. Ultimately, an insurer’s “medical and any other reasons” should be clear and sufficient enough to allow an unsophisticated person to make an informed decision to either accept or dispute the decision at issue. Only then will the explanation serve the Schedule’s consumer protection goal.
46The respondent’s letter dated June 18, 2021 denied the April 28, 2021 treatment plan. The respondent enclosed, for the applicant’s review, an insurer’s examination report completed by CanAssess and dated June 4, 2021. The letter stated that the assessors reviewed the treatment plan and “determined the treatment recommended is not reasonable and necessary from the injuries sustained in the motor vehicle accident” and therefore, the treatment would not be funded.
47I find that the respondent’s letter does not satisfy section 38(8). The denial did not provide specific details regarding the applicant’s condition that formed the basis of the respondent’s decision. Also, the enclosure of an examination report with a statement that the assessors determined that the treatment plan is not reasonable and necessary is not clear and sufficient enough to allow an unsophisticated person to make an informed decision to either accept or dispute the decision at issue and certainly does not serve the Schedule’s consumer protection goal.
48For these reasons, I find that the respondent’s denial falls short of its obligations under section 38(8). As a result, section 38(11)2 is triggered and the treatment plan is payable starting on the 11th business day after the day that the respondent received the treatment plan as the respondent no longer has the opportunity to issue a proper denial notice as a decision has been rendered regarding this medical benefit.
The applicant is not entitled to the treatment plans dated July 28, 2021 and October 27, 2021 each in the amount of $2,600.64.
49The treatment plans dated July 28, 2021 and October 27, 2021 each in the amount of $2,600.64, were completed by PRC and they each propose physiotherapy.
50The proposed goals of each treatment plan are pain reduction, increase in strength and increased range of motion. The stated functional goals are returning to activities of normal living, modified work activities, and pre-accident work activities. Barriers to recovery were identified as psycho-social impairments.
51The applicant submits that the treatment plans are reasonable and necessary despite the treatments providing temporary relief of pain. He relies upon evidence from the applicant’s psychiatrist, Dr. Allen, and the applicant’s physiotherapy records. The applicant also submits that the respondent’s denials were vague and no medical reasons were given, and that the denials amounted to deficient notices, contrary to section 38(8) of the Schedule, and therefore the respondent is liable to pay for the services in the treatment plans per section 38(11)2.
52The respondent submits that it complied with section 38(8) when denying the applicant’s benefits. It further submits that the applicant’s physical impairments directly from the subject accident are predominantly minor and do not require ongoing treatment. The respondent relies upon an assessment of the applicant on January 30, 2020 by Dr. Alan Kruger, general practitioner, resulting in a report dated February 13, 2020 wherein Dr. Kruger opined that the physical injuries were minor and no further facility based treatment was required. In addition, the respondent relies upon an assessment of the applicant on May 20, 2021 by Dr. Shafik Dharamshi, general practitioner, resulting in a report dated June 4, 2021 wherein Dr. Dharamshi opined that the physical injuries are minor and the applicant has reached maximum medical improvement.
53The applicant has not persuaded me that the respondent’s denials of treatment plans dated July 28, 2021 and October 27, 2021 failed to satisfy section 38(8). The applicant made a general allegation that the denials were vague, lacked medical reasons and amounted to deficient notices, but failed to make specific submissions regarding these specific denials and explain why they were non-compliant. It is noteworthy that the applicant did make submissions regarding specific language in other denial letters but not to the denial letters pertaining to these treatment plans.
54In any event, the denial letters dated August 10 and November 12, 2021 state that the denials are based upon a review of the documentation received from the applicant and in particular, the section 44 Medical Physician Assessment Report dated June 4, 2021 completed by Dr. Dharamshi. The letters go on to say that the Assessment Report indicated that there was no accident-related impairment identified from a musculoskeletal perspective and that the applicant had attained maximum medical improvement and maximum medical recovery from further facility-based treatment.
55I find that the respondent’s denial letters contain a “medical and any other reasons” for the denials, namely the lack of an accident-related impairment from a muscoskeletal perspective and the attainment of maximum medical improvement and maximum medical recovery. Furthermore, from a contextual standpoint, it appears the respondent specifically referred to the muscoskeletal perspective to distinguish it from psychological perspective because the respondent had approved psychological treatment. I find that the denials are clear and sufficient enough to allow an unsophisticated person to make an informed decision to either accept or dispute the decision at issue.
56Having found that the respondent complied with section 38(8), I will now address whether the treatment plans are reasonable and necessary.
57For the reasons that follow, I find that the applicant has not proven on a balance of probabilities that the treatment plans are reasonable and necessary.
58The applicant has attended regular physiotherapy since May 2019, being almost two years, and continues to report brief pain relief, often for only a few hours. Although pain relief is a legitimate goal, it is the applicant’s burden to prove on a balance of probabilities that the treatments, after two years, are reasonable and necessary, and as I will discuss, the applicant has failed to persuade me of such.
[49]
59Firstly, I do not find the physiotherapy notes of PCR supportive of the treatment plans being reasonable and necessary. Since the treatment plans in dispute were from 2021, I set out below the notes from 2021:
a. Jan. 13, 2021: pain at neck (better);
b. Feb. 17, 2021: pain at neck/upper back (better);
c. Mar. 17, 2021: pain at neck/upper back (better);
d. Mar. 24, 2021: pain at neck with headache (slightly better);
e. Apr. 7, 2021: pain at neck (slightly better). Headaches (same)
f. May 26, 2021: pain at neck with headache (slight better);
g. July 21, 2021: pain at neck with headache (slight better);
h. Sept. 29, 2021: pain at neck (better);
i. Oct. 20, 2021: pain at neck (slight better);
j. Nov. 24, 2021: pain at neck (same headache) better neck movements;
k. Dec. 22, 2021: pain neck (slight better).
It appears these notes record the applicant’s self-reporting. From PCR’s notes, it is unclear what type or degree of pain the applicant is experiencing nor the level of improvement. The use of words such as “better” and “slightly better” are not particularly descriptive and do not identify whether the applicant is “better” or “slightly better” from the commencement of the treatment that day or from the date of the previous treatment or some other time period. Also, the applicant has not directed me to objective testing. With the lack of clarity and detail in the notes, lack of objective testing, and generally an indication of limited improvement, I do not find this information supportive of the plans being reasonable and necessary.
60Secondly, Dr. Allen’s letter dated January 20, 2020 recommending that rehabilitation continue is not contemporaneous to these treatment plans (i.e. April 28, July 28 and October 27, 2021). The letter was prepared 15 months before the first treatment plan (i.e. April 28, 2021) and 21 months before the third treatment plan (October 27, 2021). I do not find Dr. Allen’s letter helpful because at the time of the letter (Jan. 20, 2020) he would not have known the applicant’s condition on or about the time of these treatment plans. Accordingly, I place little weight on it.
61Thirdly, I do not find Dr. Allen’s notes from his meetings with the applicant supportive of the treatment plans being reasonable and necessary. The applicant referred to the following notes:
i. March 9, 2021 - the applicant reported neck pain, but no pain in his shoulders and hands, but numbness.
ii. June 21, 2021 - the applicant reported having headaches every day, was taking over the counter Advil, and attending rehab which he found provided temporary relief.
iii. September 20, 2021 -the applicant reported that rehab provided help for a couple of hours but the symptoms come back.
iv. December 20, 2021- the applicant reported to experience neck pain and attending treatment every week provided some relief; “PTSD symptoms appear to have flared up again after his motor vehicle accident. This may be aggravating his physical pain as well, because anxiety produces more physical tension.”
At these various meetings, Dr. Allen does not appear to inquire as to the type and degree of pain, nor whether the pain remained constant or changed over time, and no objective testing was done. Overall, Dr. Allen’s notes confirm that the applicant reported pain and brief pain relief from rehabilitation, but Dr. Allen does not suggest or indicate that the treatment is reasonable and necessary and does not recommend that the treatment continue as he did in his January 20, 2020 letter.
62Fourthly, I find the June 4, 2021 report of Dr. Dharamshi, General Practitioner, persuasive. The assessment was done on May 20, 2021, a little over 2 years after the accident. Dr. Dharamshi recorded that the applicant advised that he was able to manage his self-care activities, without any significant difficulty, and he had not taken his hypertension medication and was informed that it may be contributing to his headaches. Dr. Dharamshi examined the applicant and noted that the applicant did not demonstrate any functional issues, had a normal neurological examination, and a normal shoulder examination. When assessing the applicant’s cervical spine it was noted the range of motion was reduced as compared to during casual/informal observation. Dr. Dharamshi diagnosed the applicant with Whiplash-associated disorder, grade 1, and cervicogenic headaches, however there was no accident-related impairment identified from a musculoskeletal perspective. Accordingly, Dr. Dharamshi opined that the applicant had reached maximum medical recovery and maximum medical improvement from a musculoskeletal perspective, and therefore further facility-based treatment was not reasonable and necessary. I find Dr. Dharamshi’s opinion persuasive, because before arriving at his opinion, he reviewed various records (e.g. hospital records, assessments, Dr. Allen’s notes, treatment plans, etc.), carried out an in-person assessment of the applicant, including a physical examination of the applicant.
63Lastly, the respondent also relied upon Dr. Dharamshi’s report to deny the treatment plans dated July 28, 2021 and October 27, 2021, although Dr. Dharamshi’s report was not prepared specifically for these plans. As of the date of these two treatment plans, I was not directed by the applicant to contemporary medical evidence that on a balance of probabilities disputed Dr. Dharamshi’s opinion that the applicant had reached maximum medical recovery and maximum medical improvement from a musculoskeletal perspective. Accordingly, I find that Dr. Dharamshi’s opinion is applicable to these disputed treatment plans.
64For the above reasons, I find that the applicant has not proven on a balance of probabilities that the treatment plans are reasonable and necessary.
The applicant is not entitled to a TENS unit in the amount of $1,025.00
65The March 18, 2020 treatment plan in the amount of $1,025.00 was completed by Mohit Rastogi, Physiotherapist, of PRC and proposed a Transcutaneous Electrical Nerve Stimulation (“TENS”) unit.
66The proposed goals of the treatment plan are pain reduction, increase in strength and increased range of motion. The stated functional goal is returning to activities of normal living. No barriers to recovery were identified.
67The applicant submits that he receives Inferential Current Therapy or TENS unit treatment at PRC on a regular basis, and he finds that it provides temporary relief, so a TENS unit at home would enable him to use it on days he is not receiving facility-based treatment. The applicant relies upon a medical article entitled “What is a TENS unit and does it work?”, updated on March 17, 2023 and found in Medical News Today. The article states that TENS is a non-invasive method of relieving pain and may be able to reduce pain medications, and the units are small and can be used throughout the day.
68The applicant submits that Dr. Kruger’s Report regarding an assessment on January 30, 2020 was completed for two treatment plans in 2019, not for the treatment plan proposing the TENS unit.
69The respondent submits that the applicant failed to provide compelling evidence that the TENS unit is reasonable and necessary. Furthermore, the Report of Dr. Kruger, general practitioner, dated February 13, 2020, determined that there was no compelling evidence for the unit.
70I find that the applicant has not proven on a balance of probabilities that the TENS unit is reasonable and necessary for the impairments caused by the accident.
71Firstly, the applicant relies upon the treatment plan itself, and that in and of itself is not sufficient as evidence. The applicant did not direct me to objective medical evidence recommending the TENS unit or supporting the position that it was reasonable and necessary. Secondly, referring to a medical article is not evidence that a TENS unit is reasonable and necessary for the applicant’s accident-related impairments. Thirdly, the applicant’s assertion that the TENS unit is helpful for a few hours, is not objective medical evidence, and accordingly not sufficient to prove on a balance of probabilities that it is reasonable and necessary.
72For the above reasons, I find that the applicant has not proven, on a balance of probabilities, that the TENS unit is reasonable and necessary.
The applicant is not entitled to physiotherapy services (chronic pain program) in the amount of $8,600.00.
73The August 27, 2020 treatment plan in the amount of $8,600.00 was completed by Dr. San Bui, Chiropractor, of the PRC, and proposed physiotherapy treatment consisting of 24 sessions of chronic pain rehabilitation sessions.
74The proposed goals of the treatment plan are “pain reduction”, “increase in strength”, “increase range of motion”, and to come up with “improved, physical, functional, emotional, cognitive and behavioral pain management strategies”. The functional goals were to “return to activities of normal living” and “return to pre-accident work activities”.
75The applicant submits that the treatment plan is reasonable and necessary, and relies upon Dr. Allen’s January 20, 2020 notes, an Occupational Therapist In Home Assessment report of Mr. Nicolas Livadas, dated February 13, 2020, and a Psychological Assessment Report of Dr. Rakesh Ratti dated September 29, 2021, as support for the treatment plan.
76The applicant submits in its Reply that the treatment plan listed six different health care providers in Part 11 that were to provide the treatment in a multi-disciplinary approach. Also, the applicant submits that Dr. Kruger’s report dated February 13, 2020 does not opine upon this chronic pain program because the report was prepared approximately seven months prior to the treatment plan.
77The respondent submits that, in its denial letter dated September 11, 2020, it notified the applicant that the treatment plan did not satisfy section 38 of the Schedule as it failed to properly list each involved practitioner in part 11 and failed to provide an accurate reflection of the proposed care to be provided in part 12. Furthermore, Dr. Hein Ta, Anesthesiologist, is identified as the sole treatment provider, but Dr. Ta did not sign the treatment plan, and when contacted, Dr. Ta was not even aware of the treatment plan nor that the applicant was a patient. Dr. Bui, Chiropractor, signed the treatment plan, but he did not have the same scope of practice as Dr. Ta which means that Dr. Bui did not qualify as a “health practitioner” under the Schedule for the purpose of submitting the treatment plan. The respondent requested that a new or amended treatment plan in compliance with section 38 be filed but the applicant never did so.
78The respondent also submits that the treatment plan was denied based upon Dr. Kruger’s report dated February 13, 2020 wherein he opines that the applicant would not benefit from any further facility-based therapy for the physical injuries sustained as a result of the subject motor vehicle accident.
79I find that the applicant has not proven on a balance of probabilities that the treatment plan is reasonable and necessary.
80Firstly, I do not find that Dr. Allen’s notes dated January 20, 2020 supportive of this chronic pain program. Dr. Allen noted that the applicant had pre-existing symptoms before the accident and reported some worsening of his symptoms since the accident, particularly headaches, fatigue, and cognitive symptoms. Dr. Allen does not recommend a chronic pain program nor recommend to the applicant that he see a professional about his pain. Accordingly, I do not see how these notes support the position that the chronic pain program is reasonable and necessary. Furthermore, Dr. Allen’s letter dated January 20, 2020 to Dr. Bui suggested rehabilitation, not a chronic pain program.
81Secondly, I do not find the Occupational Therapist In Home Assessment report of Mr. Nicolas Livadas, dated February 13, 2020, as supportive of this chronic pain program. The applicant reported neck pain, headache pain, right shoulder pain, sleep disturbance and emotional issues. Mr. Livadas opined that a barrier to the applicant resuming all his pre-accident activities was “focus on pain that is out of keeping from what would typically be expected given the nature of the injuries and given the claimant’s expected stage of recovery”. Mr. Lividas observed and concluded that the focus on pain was not typical in the circumstances. I do not see how Mr. Lividas’ report supports the position that the chronic pain program is reasonable and necessary.
82Thirdly, the Psychological Assessment Report of Dr. Rakesh Ratti, Psychiatrist, dated October 14, 2021 was prepared over one year after the treatment plan so it was not prepared for the disputed treatment plan nor is the assessment contemporaneous. Furthermore, the Report is a psychological assessment and does not recommend nor support a chronic pain program. Accordingly, I place no weight upon this Report.
83Fourthly, this treatment plan was prepared by Dr. Bui, Chiropractor. The applicant has not persuaded me that a chiropractor is qualified to recommend a chronic pain program.
84Fifthly, I find the treatment plan to be unclear, confusing, and incomplete. Although the applicant submits that there would be six health care providers, Part 12 expressly indicates that 24 chronic pain rehab sessions will be provided solely by Dr. Hien Ta, Anesthesiologist. Apparently, in support of Dr. Ta providing the treatment, a detailed resume for Dr. Ta, Anesthesiologist, was attached to the plan. No other resumes were attached. In an attachment, PRC explains why it is using a $350.00 daily rate, and in this section makes reference to the program being an integrated, interdisciplinary program, and that other providers may provide treatment to the applicant. This creates the confusion - in one place it states that Dr. Ta is providing all the treatment and in the attachment it suggests that there may be multiple providers. It is unclear which is correct. To further exacerbate the uncertainty, the plan does not set out the specific treatments to be provided to the applicant. Without identifying the specific treatments, it is not possible to explain how those treatments would meet the proposed goals to a reasonable degree.
85Lastly, despite the respondent requesting the applicant to submit a new or amended treatment plan, the applicant, for some unknown reason, did not do so.
86For the above reasons, I find that the applicant has not proven on a balance of probabilities that the treatment plan for chronic pain program is reasonable and necessary.
The applicant is not entitled to a Psychiatric Assessment in the amount of $2,200.00.
87The purpose of an assessment is to determine whether there is a reasonable possibility that the applicant has the condition the assessment is designed to investigate. The applicant bears the onus on a balance of probabilities, and therefore must point to persuasive evidence that there are grounds to suspect the condition exists.
88The March 23, 2021 treatment plan in the amount of $2,200.00 was completed by Dr. Bui and Dr. Bismonte, and proposed a psychiatric assessment.
89The applicant submits that he incurred the cost of a psychiatric assessment conducted by Dr. Maria Bismonte, Psychiatrist, and the associated report dated May 27, 2021, and he submits it is reasonable and necessary. The applicant points to the IE psychiatric assessment report of Dr. Susan Mackenzie, Psychiatrist, dated February 13, 2020, and the IE psychiatric assessment report of Dr. Rakesh Ratti, Psychiatrist, dated September 29, 2021, to support this assessment. The applicant submits that since Dr. Bismonte’s diagnoses are similar to those of Dr. Mackenzie and Dr. Ratti, the respondent should have approved the treatment plan as a result.
90The respondent submits that the treatment plan is not reasonable and necessary because it is a duplication of services. The respondent had already approved a treatment plan dated August 10, 2020 submitted by DMS proposing a psychological assessment. This approved plan resulted in a psychological assessment by Natalia Zhukova, Psychotherapist, on November 20, 2020, and a report dated December 6, 2020. The respondent approved 12 psychotherapy sessions between November 20, 2020 and July 22, 2021 that the applicant attended. Based upon subsequent Psychological Progress Reports dated July 22, 2021 and January 31, 2022 more psychotherapy sessions were approved. Also, during this time, the applicant continued to see his psychiatrist, Dr. Allen. Accordingly, the respondent submits that there was no reason for another psychological assessment at that time.
91I find that the applicant has not proven on a balance of probabilities that the psychiatric assessment is reasonable and necessary.
92Firstly, I agree with the respondent’s submissions. The applicant did not direct me to evidence as to why another psychiatric assessment was required approximately four months after the psychiatric assessment on November 20, 2020, and in the midst of psychotherapy treatment, Progress Reports, and regular visits to Dr. Allen. Accordingly, I find that the treatment plan dated March 23, 2021 proposing a psychiatric assessment is not reasonable and necessary.
93Secondly, the applicant’s submission that the treatment plan was reasonable because Dr. Bismonte’s diagnosis was similar to that found in the report of Dr. Mackenzie, Psychiatrist, dated February 13, 2020, and the opinion in the IE psychiatric report of Dr. Rakesh Ratti, Psychiatrist, dated September 29, 2021, is not evidence that the treatment plan was reasonable and necessary on March 23, 2021, the date of the treatment plan.
94Thirdly, the fact that the applicant incurred the expense for a psychiatric assessment is not evidence, in and of itself, that the disputed treatment plan is reasonable and necessary.
95For the above reasons, I find that the applicant has not proven on a balance of probabilities that the psychiatric assessment is reasonable and necessary.
The applicant is not entitled to a General Practitioner Assessment in the amount of $2,200.00.
96The February 8, 2022 treatment plan in the amount of $2,200.00 was completed by San Bui, Chiropractor, and Rodrigo Castro, Physician, of PRC, and proposed a General Practitioner assessment. The stated goals and functional goals were “to identify any illness or medical condition that might have generated due to the accident” and “to restore functional tolerance and endurance”.
97The applicant submits that he incurred the cost of the General Practitioner assessment by Dr. Castro on February 14, 2022 and the resulting report dated March 16, 2022, and submits that it is reasonable and necessary because his family doctor, Dr. Sy Hoang Nguyen, did not want to see him. The applicant relies on his report to his Psychiatrist, Dr. Allen, on December 20, 2021, that he stopped seeing his general practitioner, Dr. Nguyen, because Dr. Nguyen “did not want to continue seeing him because he had been in an accident and there is an active insurance claim”. The applicant also refers to Dr. Nguyen’s note on August 17, 2021 stating “see doctor Bui for all MVA-related problems”.
98The applicant also submits that the assessment is reasonable and necessary because Dr. Castro’s opinion that the applicant had not reached maximum medical improvement is consistent with the opinion in Dr. Ratti’s report on September 29, 2021.
99The respondent submits that the treatment plan is not reasonable and necessary based upon the report of Dr. Dharamshi, General Practitioner, dated June 4, 2021. Dr. Dharamshi opined that the applicant’s physical injuries from the accident were predominantly minor and he had reached maximal medical improvement. Furthermore, there is a lack of objective evidence from any source of any ongoing physical impairments as a result of the accident. Lastly, the respondent submits that it is unclear how another General Practitioner assessment would assist in the applicant’s recovery in relation to the injuries sustained in the accident.
100I find that the applicant has not proven on a balance of probabilities that the General Practitioner assessment is reasonable and necessary.
101Firstly, on December 20, 2021 Dr. Allen made a note that the applicant was “looking for a new family doctor now”. However, it is unclear whether the applicant continued to see Dr. Nguyen after December 20, 2021. I was not pointed to evidence as to whether a new family doctor was found, or whether any reasonable efforts were made to find a new family doctor, or whether the applicant continued to see Dr. Nguyen. This information would have been of assistance in assessing whether a General Practitioner assessment is reasonable and necessary.
102Secondly, I am not persuaded by the applicant’s submission that the treatment plan is reasonable and necessary because Dr. Castro’s opinion is consistent with Dr. Ratti’s opinion that the applicant had not reached maximum medical improvement. Each doctor assessed the applicant from different perspectives. Dr. Ratti is a Psychiatrist, not a General Practitioner. He opined that the applicant had not reached maximum medical improvement based upon a Psychological assessment, not based upon a General Practitioner’s assessment. I do not see how Dr. Ratti’s opinion from a psychological perspective supports the position that a General Practitioner assessment is reasonable and necessary.
103Thirdly, as I noted earlier, I find the June 4, 2021 report of Dr. Dharamshi, General Practitioner, persuasive. Dr. Dharamshi reviewed various medical records, carried out an in-person assessment, including a physical examination, and arrived at his opinion that the applicant’s physical injuries from the accident were predominantly minor and that he had reached maximal medical improvement from a musculoskeletal perspective, thereby supporting the respondent’s position that the treatment plan is not reasonable and necessary. Furthermore, the applicant did not direct me to objective evidence to dispute Dr. Dharamshi’s opinion, nor to support the position that a General Practitioner assessment is reasonable and necessary.
104Lastly, the fact that the applicant incurred the expense for a General Practitioner assessment is not, in and of itself, evidence that the disputed treatment plan is reasonable and necessary.
105For the above reasons, I find that the applicant has not proven on a balance of probabilities that the General Practitioner assessment is reasonable and necessary.
The applicant is not entitled to $379.69 for a psychological assessment.
106The August 10, 2020 treatment plan was completed by Disability Medicine Specialists and proposed a Psychological Assessment in the amount of $2,200.00. The respondent approved the treatment plan by a letter dated September 2, 2020. On November 17, 2021 the respondent advised the applicant, in writing, that it would pay $1,820.31, thereby leaving a balance of $379.69.
107The applicant submits that the respondent fully approved the treatment plan in the amount of $2,200.00 but only paid $1,820.31. The psychological assessment was conducted by Natalia Zhukova, Registered Psychotherapist, under the supervision of Dr. Erin Langis, Psychologist. The applicant submits that Dr. Erin Langis supervised the assessment, was involved in preparing the report, and solely formulated the psychological diagnosis of the applicant, and therefore the services should be based upon the hourly rate of a psychologist, not the hourly rate of a psychotherapist. The hourly rate of a psychologist is $149.61 but the respondent only paid $99.75 per hour thereby resulting in a balance of $379.69.
108The applicant relies upon section 4.1 of the Ontario College of Psychologists’ Standards of Professional Conduct (2017) wherein it states that members/psychologists must assume responsibility and accountability for, and review, the actions and services of all supervised providers of psychological services who are not authorized by the College to provide those services autonomously. Since Dr. Erin Langis, Psychologist, supervised Ms. Natalia Zhukova, Registered Psychotherapist, and provided counselling and formulated the diagnosis, the services provided should be based upon the hourly rate of a psychologist, not a psychotherapist.
109The respondent submits that in its letter dated September 2, 2020 it approved the treatment plan “up to $2,200.00”. The letter states that the amount payable will be adjusted depending upon who provides the services. The assessment was completed by Natalia Zhukova, Registered Psychotherapist, not by Dr. Erin Langis, Psychologist. In Dr. Langis’ Statutory Declaration dated May 13, 2021 she confirmed that she did not review the OCF-18, did not meet with or speak to the applicant, and that she prepared the report with the assistance of Ms. Zhukova. The respondent submits that, based upon the Professional Services Guideline (“Guideline”), the approved hourly rate is $99.75, and based upon that, $1,820.31 was payable.
110I find that the applicant is not entitled to $379.69 as it is not reasonable.
111Firstly, the respondent made it clear in its letter dated September 2, 2020 that it approved the plan “up to $2,200.00” and that the amount would depend upon who provided the services. The letter also gave examples of the hourly rate the respondent would pay. It stated that a psychologist’s hourly rate is “$149.61” and a psychotherapist’s hourly rate is “$58.19, provider can call to discuss rate”.
112Secondly, the Ontario College of Psychologists’ Standards of Professional Conduct regulates the conduct of psychologists but does not dictate the maximum hourly rate payable by an automobile insurer to a health care professional or provider. The maximum hourly rate is established by the Guideline.
113Thirdly, contrary to the applicant’s submission, there is no evidence that Dr. Langis was solely involved in preparation of the report. Dr. Langis’ confirmed in her Statutory Declaration dated May 13, 2021 that she did not review the OCF-18 and did not meet with or speak to the applicant, and that she prepared the report with the assistance of Natalia Zhukova and it took approximately 5.5 hours. In the Statutory Declaration, Dr. Langis did not allocate the 5.5 hours between herself and Ms. Zhukova. It is the applicant’s burden to prove what services Dr. Langis provided and the time spent providing those services. Since there is a lack of clear evidence on this matter, I cannot find, on a balance of probabilities, that Dr. Langis provided those services.
114Lastly, since Ms. Zhukova is not a psychologist, she cannot charge the maximum hourly rate of $149.61 which is available to a psychologist. The Guideline does not refer to a maximum hourly rate for a registered psychotherapist. The respondent stated in its letter dated September 2, 2022 that a psychotherapist’s hourly rate is “$58.19, provider can call to discuss rate”. There is no evidence submitted that the provider called the respondent to discuss the rate. In any event, the respondent approved an hourly rate of $99.75. In the Guideline, the maximum hourly rate for occupational therapists, physiotherapists, and podiatrists is $99.75. I find that it would be reasonable to pay a registered psychotherapist the same hourly rate as occupational therapists, physiotherapists, and podiatrists, namely $99.75.
115For the above reasons, I find that the applicant is not entitled to $379.69 for a psychological assessment.
The applicant is not entitled to $893.04 for psychological counselling.
116The January 19, 2021 treatment plan was completed by Disability Medicine Specialists and proposed psychological treatment in the amount of $3,990.50. In a letter dated March 12, 2021 the respondent approved the treatment plan. On November 17, 2021 the respondent advised the applicant in writing that it would pay $3,097.46, thereby leaving a balance of $893.04.
117The applicant submits that the respondent fully approved the treatment plan in the amount of $3,990.50 but only paid $3,097.46. The counselling was conducted by Andrew Hinkle, social worker, under the supervision of Dr. Langis, Psychologist, and therefore the services should be based upon the hourly rate of a psychologist, not the hourly rate of a social worker. The hourly rate of a psychologist is $149.61 but the respondent only paid $100.00 per hour thereby resulting in a balance of $893.04.
118The applicant relies upon section 4.1 of the Ontario College of Psychologists’ Standards of Professional Conduct (2017), that requires a psychologist to assume responsibility and accountability for, and review, the actions and services of all supervised providers of psychological services who are not authorized by the College to provide those services autonomously. Dr. Langis, Psychologist, supervised Mr. Hinkle, social worker, provided counselling and formulated the diagnosis, therefore the services should be paid based upon the hourly rate of a psychologist.
119The respondent submits that the psychotherapy treatment was provided by Andrew Hinkle, social worker. No treatment was provided by Dr. Langis. In Dr. Langis’ Statutory Declaration dated May 13, 2021 she confirmed that she did not meet with or speak to the applicant. The respondent submits that, based upon the Guideline, the approved hourly rate for a social worker is $99.75, but it rounded it up to $100.00, and based upon $100.00 per hour, $3,097.46 was payable.
120I find that the applicant is not entitled to $893.04 as it is not reasonable.
121Firstly, as stated earlier, the Ontario College of Psychologists’ Standards of Professional Conduct regulates the conduct of psychologists but does not dictate the maximum hourly rate payable by an automobile insurer to a health care professional or provider. The maximum hourly rate is established by the Guideline.
122Secondly, the applicant has not directed me to any compelling evidence that Dr. Langis provided treatment to the applicant. In fact, Dr. Langis confirmed in her Statutory Declaration that she never met or spoke to the applicant, so it is not possible that she provided psychotherapy to the applicant.
123Thirdly, since Mr. Hinkle is not a psychologist, he cannot charge the maximum hourly rate of $149.61 that is available only to a psychologist. The Guideline does not refer to a maximum hourly rate for a social worker. However, the Guideline does stipulate a maximum hourly rate of $99.75 for occupational therapists, physiotherapists, and podiatrists. I find that it would be reasonable to pay a social worker an hourly rate similar to that of an occupational therapists, physiotherapists, and podiatrists. The respondent approved an hourly rate of $100.00 for Mr. Hinkle, and I find that reasonable.
124For the above reasons, I find that the applicant is not entitled to $893.04 for psychological counselling.
The Applicant is entitled to Interest.
125Pursuant to s. 51 of the Schedule, the applicant is entitled to interest on any overdue payment of benefits.
The Applicant is not entitled to an Award.
126Under s. 10 of Reg. 664, the Tribunal may award up to 50 per cent of the total benefits payable if it determines that the insurer unreasonably withheld or delayed the payment of benefits. For conduct to attract a s. 10 award, the conduct must rise above being an incorrect decision and be “excessive, imprudent, stubborn, inflexible, unyielding or immoderate”: see Plowright v Wellington Insurance Co., 1993 OIC File A-003985 (FSCO). The applicant has the burden with respect to a special award.
127The applicant submits that the respondent removed the applicant from the MIG based on psychological impairments but continued to maintain his physical injuries are minor despite evidence from Dr. Allen, PRC and its own psychological assessments.
128The respondent submits that it reviewed all documentation produced by the applicant and provided them to its assessors. Further, it submits that the applicant failed to produce medical evidence to substantiate his claim that as a result of the subject accident his physical injuries were not predominantly minor and that they affected his ability to function. Accordingly, the treatment plans were properly denied.
129It is well settled that an award should not be ordered simply because an insurer made an incorrect decision. Rather, in order to attract a section 10 award the applicant must prove on a balance of probabilities that the insurer unreasonably withheld or delayed the payment of benefits and that the conduct was excessive, imprudent, stubborn, inflexible, unyielding or immoderate.
130Although I found four treatment plans to be reasonable and necessary, and section 38(8) was not complied with regarding another, this does not, in and of itself, mean that the benefits were unreasonably withheld or delayed. Making incorrect decisions is not enough. The respondent decided based upon the evidence before it that the applicant was outside the MIG because of psychological impairments but that his physical injuries were predominantly minor. The applicant’s physical injuries were assessed based upon information provided by the applicant together with two general practitioner assessments. The applicant has not shown, on a balance of probabilities, that there was an unreasonable withholding or delay of benefits. Furthermore, the applicant has not persuaded me that the respondent’s conduct rose to the level of excessive, imprudent, stubborn, inflexible, unyielding or immoderate.
131Accordingly, I find that the applicant is not entitled to an award.
ORDER
132For the above-noted reasons, I find that:
a. The applicant is entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated March 18, 2020, and interest pursuant to s. 51 of the Schedule.
b. The applicant is entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated July 15, 2020 and interest pursuant to s. 51 of the Schedule.
c. The applicant is entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated October 6, 2020 and interest pursuant to s. 51 of the Schedule.
d. The applicant is entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated January 6, 2021 and interest pursuant to s. 51 of the Schedule.
e. The applicant is entitled to $2,600.64 for physiotherapy services, proposed by Pain Rehabilitation Clinic in a treatment plan dated April 28, 2021, and interest pursuant to s. 51 of the Schedule.
f. The applicant is not entitled to any other treatment plans in dispute.
g. The applicant is not entitled to an award.
Released: November 18, 2024
Nick Iannazzo
Adjudicator