Licence Appeal Tribunal File Number: 21-006036/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:
Julie Bajor
Applicant
and
Aviva Insurance Company of Canada
Respondent
DECISION
ADJUDICATOR:
Janet Rowsell
APPEARANCES:
For the Applicant:
Ian Drong, Counsel
For the Respondent:
Kathleen Mertes, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Julie Bajor, the applicant, was involved in an automobile accident on March 14, 2018, 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.
ISSUES
2The issues in dispute are:
i. Is the applicant entitled to $1,665.76 for natural supplements and cannabis oil, submitted on an Expense Claim Forms (OCF-6s) dated July 8, 2018; September 6, 2018, October 9 & 16, 2018, November 26, 2018, and February 12 & 16, 2019?
ii. Is the applicant entitled to $1,927.61 for medications proposed by Medical Marijuana Group Consulting Ltd in a treatment plan/OCF-18 (“plan”) dated June 15, 2019?
iii. Is the applicant entitled to $2,500.00 for Platelet Rich Plasma - Regen proposed by High Mark Health Mississauga (“High Mark”) in a plan dated September 5, 2019 and submitted September 6, 2019?
iv. Is the applicant entitled to $1,500.00 for physiotherapy proposed by Highmark in a plan dated February 26, 2021?
v. Is the applicant entitled to $1,400.00 ($2,750.00 less $1,350.00 approved) for psychological services proposed by High Mark in a plan dated January 16, 2021?
vi. Is the applicant entitled to $700.00 for a Visual Assessment proposed by HighMark in a plan dated June 25, 2021?
vii. Is the applicant entitled to $1,097.50 for physiotherapy proposed by HighMark in a plan dated June 25, 2021?
viii. Is the applicant entitled to $349.14 for massage therapy proposed by Synergy Wellness in a plan dated December 30, 2021?
ix. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant is not entitled to the OCF-6s/Expense Claim Forms for Natural Supplements, Cannabis Oil, Argyle Oil, and Yellow Oil in the amount of $1,665.76.
4The applicant is not entitled to $1,927.61 for medications proposed by Medical Marijuana Group Consulting Ltd., in a treatment plan/ OCF-18 (“plan”) dated June 15, 2019. Particularly since
5The applicant is not entitled to $2,500.00 for Platelet Rich Plasma - Regen, by the operation of section 15(2)(a) of the Schedule.
6The applicant is not entitled to the OCF-18’s for physiotherapy treatment.
7The applicant is not entitled to $1,400.00 ($2,750.00 less $1,350.00 approved) for psychological services.
8The applicant is not entitled to $1,400.00 ($2,750.00 less $1,350.00 approved) for psychological services.
9The applicant is not entitled to $700.00 for a Visual Assessment.
10The applicant is not entitled to $349.14 for a massage therapy.
11The applicant is not entitled to interest on overdue payments of benefits pursuant to s. 51 of the Schedule.
ANALYSIS
OCF-6/ Expense Claim forms (OCF-6s) dated July 8, 2018; September 6, 2018, October 9 & 16, 2018, November 26, 2018, and February 12 & 16, 2019, for Natural Supplements, Cannabis Oil, Argyle Oil, and Yellow Oil,
12I find that the natural supplements the applicant seeks entitlement to, namely argyle oil, yellow oil, and cannabis oil, are not reasonable and necessary accident-related expenses, pursuant to s.15(1)(c) of the Schedule particularly since I do not find the submitted medical evidence supportive of the claims. I find the medical evidence is not supportive of the natural supplements, argyle oil, yellow oil, and cannabis oil, being reasonable and necessary as accident-related expenses pursuant to s.15(1)(c) of the Schedule.
13The applicant claims expenses in the amount of $1,665.76 provided by way of an Expenses Claim Form (“OCF-6”) dated July 8, 2018; September 6, 2018, October 9 & 16, 2018, November 26, 2018, and February 12 & 16, 2019.
14Section 15(1) of the Schedule sets forth that subject to section 18, medical benefits shall pay for all reasonable and necessary expenses incurred by or on behalf of the insured person as a result of the accident, including expenses for medication, and other goods and services of a medical nature that the insurer agrees are essential for the treatment of the insured person, and for which a benefit is not otherwise provided in this Regulation. The natural supplements in dispute are experimental as a form of treatment.
OCF-6 Forms Proposing Natural Supplements
15I do not find that the medical expenses in the amount of $241.16 and $156.74 for natural supplements are reasonable and necessary pursuant to the Schedule.
16The applicant submits that by using natural supplements, including Omega 3, that she has been able to address her accident-related symptoms of headaches, insomnia, anxiety, and chronic pain. The applicant describes that her family physician Dr. Ugonwa Dag-Ellams, and the concussion clinic attended by the applicant, are supportive of her use of natural supplements. The Disability Certificate OCF-3 prepared by family physician Dr. Ugonwa Dag-Ellams, dated March 27, 2018, sets forth that the applicant has been prescribed Tylenol, Advil and Symbiocort for the purpose of addressing accident-related injuries.
17The respondent relies on the IE Musculoskeletal Examination, of Dr. Michael Hanna, dated April 22, 2019, which states that there is no medical evidence that the natural supplements and Omega 3 are necessary to address the applicant’s injuries sustained in the accident. The respondent submits that Dr. Hanna opines in his report that the natural supplements are not reasonable and necessary expenses, on the basis that there is no medical evidence that the supplements are essential in addressing the applicant’s accident-related impairments.
18I find that the applicant has failed to meet her burden to show that the natural supplements including Omega 3 supplements proposed in the OCF-6, dated July 8, 2018, and September 6, 2018, are reasonable and necessary expenses essential for the treatment of the applicant. I agree with the respondent that there is no medical evidence to support that the supplements are a reasonable and necessary expense to address the applicant’s accident-related impairments.
OCF-6 Forms Proposing Cannabis Oil, Argyle Oil, and Yellow Oil
19I find that the medical expenses for Cannabis Oil in the amount of $438.44, $117.52 and $262.16 for Argyle Oil, and $241.82, and $207.92 for the expense for Yellow Oil, are not reasonable and necessary expenses payable by the respondent pursuant to the Schedule.
20The applicant submits that by using cannabis oil that she has been able to address her accident-related symptoms of headaches, insomnia, anxiety, and chronic pain. The applicant submits that in October 2021, Nurse Practitioner Harpeet Kaur prescribed cannabis oil, yellow and argyle oil to address the accident-related impairments of anxiety, insomnia and chronic pain. The respondent relies on the section 44 IE musculoskeletal assessment report of Dr. Michael Hanna (Physician), dated May 7, 2019, where Dr. Hanna concludes that medical marijuana is not a reasonable and necessary expense, contraindicated in the applicant’s situation due to the applicant’s asthma, lymphoma, and cardiovascular disease.
21The respondent submits that Dr. Hanna’s position is supported by the applicant’s treatment providers from the medical records of Dr. Maria Tartaglia, Physician with the University Health Network’s Concussion Clinic, dated September 3, 2020, where Dr. Tartaglia recommends that the applicant taper off using THC (tetrahydrocannabinol), as it causes depression, anxiety, and cognitive impairment. Dr. Hanna outlined in his IE assessment report that academic/medical studies suggest that medical cannabis should be used with caution and only when all other therapeutic options have been exhausted and failed to alleviate the patient’s symptoms.
22I find that the applicant has failed to meet her burden to show that the Cannabis Oil, Argyle Oil and Yellow Oil, proposed in the OCF-6, dated October 9 & 16, 2018, November 26, 2018, and February 12 & 16, 2019, are reasonable and necessary expenses essential for the treatment of the applicant. I prefer the evidence in Dr. Hanna’s assessment and the opinion of Dr. Maria Tartaglia of the University Health Network, to the effect that the use of medical marijuana is contraindicated in the applicant’s case. More importantly, there is no evidence that all other therapeutic options have been exhausted and failed to alleviate the applicant’s symptoms.
23I find the treatment plan recommending that medicinal marijuana as a treatment for the applicant’s injuries sustained in the accident is not reasonable and necessary. I find that the corroborating contemporaneous and objective medical evidence shows that medicinal marijuana is not only a non-essential treatment for the applicant but may be contraindicated based on the applicant’s pre-existing conditions.
24To 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.
25The Tribunal has held that treatment plans by themselves do not prove that proposed treatments are reasonable and necessary. There should be corroborating contemporaneous and objective medical evidence to substantiate the necessity and reasonableness of the proposed treatment: See, e.g. SY and Aviva, 2017 CanLII 63623 (ON LAT), at para 19.
26The treatment plan completed by Harpreet Kaur, Nurse Practitioner, recommends documentation, education and care coordination, prescription support activity, and the provision of medical marijuana for the treatment of nonorganic insomnia, chronic pain, anxiety, concussion, headache, and sprain and strain of the applicant’s cervical and thoracic spine.
27The applicant relies on the prescription and medical record of October 2021, by Nurse Practitioner Harpeet Kaur, where she prescribes cannabis oil, yellow and argyle oil to address the applicant’s accident-related impairments. The respondent relies on the musculoskeletal paper review of Dr. Micheal Hanna dated July 22, 2019, where Dr. Hanna opines that the treatment plan recommending the use of medical marijuana to treat the applicant’s injuries caused by the accident is not reasonable and necessary. Dr. Hanna opines that the treatment plan is not reasonable and necessary and in fact contraindicated in the applicant’s case due to her pre-existing history of asthma, respiratory condition, lymphoma, and her risk factors for cardiovascular disease. The respondent also relies on the opinion of Dr. Tartaglia supporting Dr. Hanna’s assessment, as discussed earlier.
28I find that the applicant has failed to meet her burden to show that the treatment plan, is reasonable and necessary. I prefer the evidence in Dr. Hanna’s paper review, supported by the opinion of Dr. Maria Tartaglia of the concussion clinic of the University Health Network, to the effect that the use of medical marijuana is contraindicated in the applicant’s case. As stated, the applicant’s physicians, are in agreement with Dr. Hanna regarding the use of medical marijuana as ill-advised. Dr. Maria Tartaglia, Physician with the University Health Network’s Concussion Clinic, in her report dated September 3, 2020, recommends that the applicant taper off using THC (tetrahydrocannabinol), as it causes depression, anxiety, and cognitive impairment.
29For reasons that follow, I find that the respondent is not liable to pay the medical benefits proposed in the treatment plan of Dr. Christopher Mazza, recommending Platelet Rich Plasma - Regen, by reason of section 15(2)(a) of the Schedule. Section 15 (2) of the Schedule sets forth that an insurer is not liable to pay medical benefits for goods and services which are experimental in nature. Based on the evidence provided by the applicant and respondent, it is clear that Platelet Rich Plasma – Regen (PRP) treatment is experimental in nature. The analysis of whether the treatment plan is reasonable and necessary within the meaning of section 15(1) of the Schedule is not a consideration in the alternative, as I am directed by the regulation to strictly apply section 15(2)(a), on the basis of evidence that PRP treatment is experimental in nature and therefore the respondent is not liable to pay the PRP medical benefits.
30Dr. Mazza proposed in a treatment plan dated September 5, 2019, to address the applicant’s concussion, low back pain, headache, whiplash-associated complaint of neck pain, stiffness and tenderness, with PRP-Regen treatment. The purpose of the treatment plan is to improve the applicant’s range of motion, increase her strength and improve the applicant’s pain relief.
31The applicant contends that PRP treatment is a progressive approach to the treatment of the applicant’s right rotator cuff partial thickness tear. The applicant relies on Dr. Mazza’s recommendation that the applicant is a candidate for PRP therapy. The applicant was diagnosed with a right rotator cuff partial thickness tear, on August 8, 2019. Dr. Mazza considers the applicant a candidate for PRP therapy together with other rehabilitative exercises and manual treatment.
32The respondent denied the treatment plan dated September 5, 2019, on the basis that the proposed treatment of Platelet Rich Plasma (PRP) therapy is experimental, and, therefore, not payable pursuant to section 15(2)(a) of the Schedule.
33The respondent submits that the medical consensus is that PRP therapy remains classified as an experimental treatment. The respondent supports its position, citing Health Canada’s statement on its website that PRP treatment lacks scientific evidence of its safety, efficacy, and quality in clinical trials. In addition, the respondent supports the position that PRP therapy is experimental by citing the fact that the treatment is not included as a treatment with OHIP coverage.
34The applicant submitted, an Information Update dated July 26, 2019, published by Health Canada, stating that the Canadian Department of Health, has not reviewed scientific evidence on PRP for therapeutic use. I find the applicant’s documentary evidence included to support the treatment plan as reasonable and necessary, substantiates the respondent’s submission that PRP therapy is experimental in nature pursuant to section 15(2) (a) of the Schedule, and therefore not payable.
35I find that the respondent is not liable to pay the medical benefits proposed in the treatment plan of Dr. Mazza, recommending PRP treatment as experimental in nature, by reason of the operation of section 15(2)(a) of the Schedule. Based on the evidence provided by the applicant and respondent, it is clear that PRP treatment is experimental in nature. The analysis of whether the treatment plan is reasonable and necessary within the meaning of section 15(1) of the Schedule is not a consideration in the alternative, as I am directed by the regulation to strictly apply section 15(2)(a).
36I find that the applicant has failed to meet her burden to show that the physiotherapy treatment plan proposed by Hillary Johannson, Physiotherapist, dated June 25, 2021, is reasonable and necessary.
37Physiotherapist Hillary Johannson proposed a treatment plan dated June 25, 2021, to address the applicant’s concussion, headache, post concessional syndrome, visual disturbance and post-traumatic stress disorder with physiotherapy treatment to increase the applicant’s range of motion and to assist the applicant return to the activities of normal living.
38Physiotherapist Hillary Johannson proposed in a treatment plan dated February 26, 2021, an additional twenty weeks of physiotherapy to address the applicant’s injuries sustained in the accident consisting of sprain and strain of the cervical spine, concussion, low back pain and whiplash-associated disorders.
39I find the IE Neurological Assessment by Dr Adrian Fawcett dated July 30, 2021, offers a reliable opinion regarding the treatment plan for physiotherapy. Dr. Fawcett states following an examination of the applicant that the headaches which the applicant experiences are multifactorial including a mild traumatic brain injury sustained in the accident. Dr. Fawcett’s opinion as a Neurologist, is that physiotherapy will not improve the applicant’s post-concussive symptoms. Dr Fawcett finds and offers the opinion that the treatment plan dated June 25, 2021, is not reasonable and necessary for the purpose of addressing the applicant’s accident-related injuries with physiotherapy treatment.
40The applicant relies on the treatment recommendations of Dr. Cristina Saverino in her neurocognitive assessment report supportive of physiotherapy treatment. The applicant submits that the physiotherapy treatment plan is reasonable and necessary to address the applicant’s physical pain symptomology and her post-concussive symptoms. Dr. Saverino recommends the applicant continue with physiotherapy to manage her post-concussive symptoms such as neck pain, headaches, and fatigue. The applicant submits that Dr. Saverino comments that studies recommend the benefits of physiotherapy and botox injections.
41However, I find that Dr. Saverino, as a clinical psychologist, is not qualified and is outside the scope of her expertise opining regarding the applicant’s symptoms of neck pain and headaches addressed by physiotherapy. I place little evidentiary weight on Dr. Saverino’s opinions relating to the benefits of physiotherapy and botox injections for the physical injuries sustained by the applicant as a result of the accident. In addition, Dr. Saverino’s references in her neurocognitive assessment, research studies which are not cited, therefore, of little probative value.
42I also find that the applicant has failed to meet her burden to show that the physiotherapy treatment plan proposed by Hillary Johannson, dated February 26, 2021, is reasonable and necessary. Here Ms. Johnson proposed an additional twenty weeks of physiotherapy to address the applicant’s injuries sustained in the accident consisting of sprain and strain of the cervical spine, concussion, low back pain and whiplash-associated disorders. The applicant also relies on Dr. Saverino, as discussed above.
43The respondent relies on the IE Musculoskeletal Examination report of Dr James Stewart, dated April 16, 2021. Dr Stewart opines that he found no objective clinical findings of any ongoing accident-related musculoskeletal impairment identifiable. Dr. Stewart found that the proposed treatment plan dated February 26, 2021, for an additional twenty weeks of physiotherapy treatment, was not reasonable and necessary based on the applicant having no identifiable musculoskeletal impairment. I find the opinion of Dr. Stewart more reliable than that of Dr. Saverino because she opined outside the scope of her expertise.
44I find that the applicant has failed to meet her burden to show that the treatment plan proposed by Hillary Johannson, Physiotherapist, dated February 26, 2021, is reasonable and necessary. The respondent relies on the IE Musculoskeletal Examination report of Dr James Stewart, dated April 16, 2021. Dr Stewart opines that he found no objective clinical findings of any ongoing accident-related musculoskeletal impairment identifiable. Dr. Stewart found that the proposed treatment plan dated February 26, 2021, for an additional twenty weeks of physiotherapy treatment, was not reasonable and necessary based on the applicant having no identifiable musculoskeletal impairment. I find the opinion of Dr. Stewart more reliable than that of Clinical Psychologist Dr. Cristina Saverino in her neurocognitive assessment report, by reason of Dr. Saverino opining outside the scope of her expertise.
45I find that the applicant has failed to meet her burden to show that the treatment plan proposed by Hillary Johannson, Physiotherapist, dated June 25, 2021, is reasonable and necessary. I find the IE Neurological Assessment by Dr Adrian Fawcett, Neurologist, dated July 30, 2021, offers a reliable opinion regarding the treatment plan for physiotherapy. Dr Fawcett states following an examination of the applicant that the headaches which the applicant experiences are multifactorial including a mild traumatic brain injury sustained in the accident. Dr. Fawcett’s opinion as a Neurologist, is that physiotherapy will not improve the applicant’s post-concussive symptoms.
Massage Therapy Treatment Plan
46I find that the applicant has failed to meet her burden to show with medical evidence that the treatment plan recommending massage therapy is reasonable and necessary.
47David Giannone, Chiropractor, proposed a treatment plan for physical rehabilitation through massage therapy over 24 weeks, to support pain management and to return the applicant to her activities of normal living. The applicant submits that massage therapy has improved the applicant’s experience of headaches. The applicant submits that the respondent is ignoring the role massage therapy plays in the applicant’s concussion management and recovery. The respondent in the explanation of benefits states that the treatment plan is neither reasonable nor necessary by reason of the findings in the Insurer’s Examination dated April 16, 2021, by Dr. Stewart.
48The respondent also describes in the EOB that the treatment plan by David Giannone, describes the existence of nerve root injury to the cervical spine of the applicant, which it asserts has no such finding, confirmed in imaging or medical studies of the applicant.
49The IE Musculoskeletal Examination report of Dr. Stewart, dated April 16, 2021, opines that from a musculoskeletal perspective, the applicant demonstrated a full and pain free range of motion in all regions. Dr Stewart opines that he found no objective clinical findings of any ongoing accident-related musculoskeletal impairment identifiable.
50The respondent relies on the IE Musculoskeletal Examination report of Dr James Stewart, dated April 16, 2021, which opines that from a musculoskeletal perspective except for some general myofascial tenderness over the cervical paraspinal, trapezius and rhomboids muscles bilaterally, the applicant had no functional impairments. The neurological screen for motor, sensation and reflexes were normal. For the purpose of the assessment, the applicant demonstrated a full and pain free range of motion in all regions. Dr. Stewart opines that he found no objective clinical findings of any ongoing accident-related musculoskeletal impairment. Dr. Stewart found that the proposed treatment plan dated February 26, 2021, for an additional twenty weeks of physiotherapy treatment, was not reasonable and necessary based on the applicant having no identifiable musculoskeletal impairment.
51Dr. Stewart opines that from a musculoskeletal perspective, except for some general myofascial tenderness over the cervical paraspinal, trapezius and rhomboid muscles bilaterally, the applicant had no functional impairments. The neurological screen for motor, sensation and reflexes were normal. Dr Stewart opines that he found no objective clinical findings of any ongoing accident-related musculoskeletal impairment.
52I find that the applicant has failed to meet her burden to show with medical evidence that the treatment plan recommending massage therapy is reasonable and necessary.
53I find that the applicant has failed to meet her burden to show that the treatment plan proposed by Ronald Gall, Optometrist, for a visual assessment, is reasonable and necessary. I find the IE Neurological Assessment by Dr Adrian Fawcett, Neurologist, dated July 30, 2021, offers a reliable opinion regarding the treatment plan recommending the visual assessment not being reasonable and necessary. I do not find that the applicant has provided sufficient evidence in the CNR’s of the family physician Dr. Ugonwa Dag-Ellams, to meet her burden showing the treatment plan proposing a visual assessment is reasonable and necessary.
54Mr. Gall, Optometrist, proposed a treatment plan for a visual assessment for the purpose of returning the applicant to the activities of normal living, by addressing the applicant’s concussion, headache, post-concessional syndrome, visual disturbance, and PTSD.
55The applicant submits that a visual assessment is reasonable and necessary to address the vision and vestibular concussion related issues which the applicant submits she is experiencing. The applicant relies on the clinical notes and records (CNR’s) of family physician Dr. Dag-Ellams. The CNRs of Dr. Dag-Ellams contain the applicant’s reports of headaches post-accident. The applicant underwent an MRI of her head on July 13, 2018, and a head CT on March 25, 2018, which showed no acute intracranial abnormality.
56As stated, the respondent rests its denial on the IE Neurological Assessment by Dr. Adrian Fawcett. Dr Fawcett states that, following an examination of the applicant, her pupils were reactive to light; her visual fields were full; and her extraocular movements were normal. The applicant significantly did not report any symptoms of visual difficulty to Dr. Fawcett. Dr. Fawcett finds the treatment plan for a visual assessment is neither reasonable nor necessary since he does not find that on a neurologic review of the applicant’s symptoms that she has any ocular, focal motor, focal sensory, or cognitive symptoms indicating that a visual assessment is required.
57As stated, I find that the applicant has failed to meet her burden to show that the treatment plan proposed by Ronald Gall, Optometrist, for a visual assessment, is reasonable and necessary. I find the IE Neurological Assessment by Dr Adrian Fawcett, Neurologist, dated July 30, 2021, offers a reliable opinion regarding the treatment plan recommending the visual assessment. I do not find that the applicant has provided sufficient evidence in the CNR’s of the family physician Dr. Dag-Ellams, to meet her burden showing the treatment plan proposing a visual assessment is reasonable and necessary.
58I find that the applicant has failed to meet her burden to show that the treatment plan for psychological services, proposed by Dr. Christopher Mazza, dated January 16, 2021, is reasonable and necessary. I prefer the evidence in the IE Examination and Psychological Assessment, undertaken by Dr. Rodney Day, in person, including psychological testing on March 15, 2021, as opposed to the remote psychological testing process, employed by Dr. Cristina Saverino, when she conducted her psychological assessment of the applicant. I, therefore, find Dr. Day’s findings more reliable as they are also corroborated by the earlier psychological assessment results of Dr. Aleksandra Nesovic, dated May 7, 2019.
59Dr. Mazza, proposed a treatment plan dated January 16, 2021, recommending twenty sessions of psychotherapy counselling to be provided to the applicant with a social worker. The respondent approved twelve of the twenty proposed psychological counselling sessions recommended in Dr Mazza’s treatment plan.
60The applicant relies on the psychological assessment report of Dr. Saverino in support of the treatment plan, in addition to the recommendation by Social Worker Peggy O’Neil. Ms. O’Neill recommended continued psychotherapy using cognitive behavioural therapy for the applicant. Ms. O’Neil addressed the continued value of psychological counselling in order to address the applicant’s post-concussive symptoms of depression. However, Ms. O’Neill did not suggest the amount of psychological counselling which would be of assistance to the applicant in order for her to meet maximal medical recovery.
61The applicant submits that Dr. Saverino conducted a psychological assessment which resulted in the applicant being diagnosed with Post Traumatic Stress Disorder (PTSD) and Somatic Symptom Disorder. Dr. Saverino recommended eighteen sessions of psychological counselling as appropriate for the applicant.
62I find the circumstances of the applicant’s psychological testing by Dr. Saverino, results in her psychological testing being less reliable medical evidence than the in-person psychological testing by Dr. Day. Dr. Saverino conducted her clinical interview of the applicant through a web-based platform and the psychological testing was carried out independently using a remote online assessment tool. The IE Examination and Psychological Assessment undertaken by Dr. R. Day was in person on March 15, 2021, including psychological testing. Dr. Day was able to observe the applicant and observe the integrity of the testing process, as opposed to remote sessions with the limitation acknowledged by Dr. Saverino of her inability to make observations of the applicant during remote psychological testing to ensure independent responses.
63I find the differences in the methods of psychological testing result in Dr. R. Day’s assessment process being more reliable with the applicant physically present when she underwent testing. Dr. Day opined that the applicant had not reached maximal medical recovery at the time of his assessment dated March 29, 2021, although the applicant was much improved from her psychological condition in the year 2019. The applicant met the diagnostic criteria for adjustment disorder with mixed anxiety and depressed mood. Dr Day recommended the provision of twelve, one-hour sessions of counselling as reasonable and necessary. The respondent submits that the treatment plan for psychological services dated January 16, 2021, was partially approved following the IE section 44 Psychological Assessment of Dr. Rodney Day by reason of Dr. Day’s findings being more reliable than the findings of Dr. Saverino.
64Dr Day’s diagnosis of the applicant is similar to that of Dr. Aleksandra Nesovic, in his IE Psychological Assessment report which took place on May 7, 2019. Dr. Nesovic found the applicant met the DSM-5 diagnostic criteria for an adjustment disorder with Mixed Anxiety and Depressed Mood as a direct result of the psychological impairments sustained in the accident. Dr. Nesovic prepared an IE Psychological Addendum report based on additional medical information which confirmed his opinion offered in her assessment dated May 7, 2019.
65As stated, I prefer the opinion of Dr R. Day to the opinion of Dr. Saverino, regarding the number of psychological counselling sessions which are reasonable and necessary, and appropriately approved. Dr. Day’s testing methodology affords greater reliability than Dr. Saverino’s. I prefer the psychological testing results of Dr. R. Day by reason of his findings being corroborated by Dr. Aleksandra Nesovic, as a result of her IE Psychological Assessment report which took place on May 7, 2019. I am, therefore, not persuaded that the balance of the treatment plan is reasonable and necessary.
ORDER
66I find none of the treatment plans are reasonable and necessary. As no benefits are overdue, it follows that no interest is payable.
ORDER
67The applicant is not entitled to the OCF-6s/Expense Claim forms dated July 8, 2018 September 6, 2018, October 9 & 16, 2018, November 26, 2018, and February 12 & 16, 2019, for Natural Supplements, Cannabis Oil, Argyle Oil, and Yellow Oil in the amount of $1,665.76.
68The applicant is not entitled to $1,927.61 for medications proposed by Medical Marijuana Group Consulting Ltd. In a treatment plan/OCF-18 (“plan”) dated June 15, 2019.
69The applicant is not entitled to $2,500.00 for Platelet Rich Plasma - Regen in a plan dated September 5, 2019 and submitted September 6, 2019, by the operation of section 15(2)(a) of the Schedule.
70The applicant is not entitled to the OCF-18’s for physiotherapy treatment proposed in plans dated February 26, 2021, and June 25, 2021.
71The applicant is not entitled to $1,400.00 ($2,750.00 less $1,350.00 approved) for psychological services as per the OCF-18 dated January 26, 2021.
72The applicant is not entitled to $700.00 for a Visual Assessment as per an OCF-18 dated June 25, 2021.
73The applicant is not entitled to $349.14 for a massage therapy as per the OCF-18 dated December 30, 2021.
74As no benefits are overdue. The applicant is not entitled to interest.
75The application is dismissed.
Released: January 10, 2024
Janet Rowsell
Adjudicator