Licence Appeal Tribunal File Number: 22-005181/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:
Michelle Foster
Applicant
and
Co-operators General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Tanjoyt Deol
APPEARANCES:
For the Applicant:
Maia Bent, Counsel
Stephanie C. Coppens, Counsel
For the Respondent:
Emily Schatzker, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Michelle Foster, the applicant, was involved in an automobile accident on March 22, 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 Co-operators General Insurance Company, the respondent, 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 $2,700.00 for social work services, proposed by Tammie Ross in a treatment plan/OCF-18 (“OCF-18”) submitted on November 1, 2021?
ii. Is the applicant entitled to $4,449.36 for cannabis, submitted on a claim form (“OCF-6”) submitted on June 30, 2021?
iii. Is the applicant entitled to $1,832.79 for cannabis, submitted in an OCF-6 submitted on September 10, 2021?
iv. Is the applicant entitled to $1,808.00 for cannabis, submitted in an OCF-6 submitted on October 26, 2021?
v. Is the applicant entitled to $517.98 for cannabis, submitted in an OCF-6 submitted on August 5, 2022?
vi. Is the applicant entitled to $7,411.83 for Case Management Services and a Cefaly Device proposed by Susan Waymouth in an OCF-18 submitted on June 23, 2022?
vii. Is the applicant entitled to $3,591.04 ($3,791.04 less $200.00 approved) for vestibular physiotherapy, proposed by Lisa Souliere in an OCF-18 submitted on September 19, 2022?
viii. Is the applicant entitled to interest on any overdue payment of benefits?
3The Case Conference Report and Order, released on February 25, 2023, indicates that for issue (vii), $648.88 was approved and therefore the remaining balance is $3,412.16. However, the respondent in its submissions, has confirmed that $200.00 was approved, and therefore the remaining balance is $3,591.04.
RESULT
4I find that:
i. The applicant is entitled to the November 1, 2021 OCF-18 in the amount of $2,700.00 for social work services plus interest for this OCF-18 in accordance with s. 51 of the Schedule;
ii. The applicant is not entitled to a remaining balance of $3,591.04 for the September 19, 2022 OCF-18 for vestibular physiotherapy;
iii. The applicant is not entitled to the June 23, 2022 OCF-18 in the amount of $7,411.83 for Case Management Services and a Cefaly Device; and
iv. The applicant is entitled to the OCF-6s for cannabis plus interest in accordance with s. 51 of the Schedule.
ANALYSIS
The Treatment Plans
5To 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.
The applicant is entitled to the November 1, 2021 OCF-18 in the amount of $2,700.00 for social work services
6I find that the applicant has demonstrated on a balance of probabilities that the OCF-18 for social work services is reasonable and necessary.
7The disputed OCF-18 requests 12 sessions for 1.25 hours of social work counselling to be provided by Ms. Tammie Ross, social worker. The OCF-18 also includes costs for: preparing the treatment plan, time associated with planning and communication with the treatment team, and the completion of a social work progress report.
8The applicant submits that it is not disputed that she suffers from severe psychological injuries, which include: severe depression, anxiety symptomatology, impaired daily functioning, and frequent suicidal thoughts. She further argues that she was previously receiving social work treatment with Ms. Ross in September of 2018, which helped to decrease her depression and anxiety. However, the applicant continued to have difficulties with social anxiety, passenger anxiety, frustration, and disrupted sleep. To this end, the applicant relies upon the s. 25 report of Dr. Heather Bromley Little, the applicant’s treating psychologist, dated January 31, 2022.
9Meanwhile, the respondent argues that it has already approved social work services from 2018 to 2020, and psychological treatment with Dr. Little since early 2021. It argues that it denied the proposed services, based upon the s. 44 psychology report of Dr. Ivan Kiss, neuropsychologist, as he opined that the applicant should focus on psychotherapy and pharmacotherapy instead of social work services. Lastly, it argues that the proposed services are duplicative, and that the applicant has not pursued other recommended modalities, such as an interdisciplinary pain management program and a review of her medication by a psychiatrist.
10There is no disagreement between the parties that the applicant sustained psychological impairments as a result of the accident, as this is supported by the reports of both Dr. Kiss and Dr. Little. Instead, the disagreement arises from how to treat these psychological impairments. In this regard, I place greater weight on the evidence relied upon by the applicant over the respondent’s evidence.
11First, I place more weight on the opinion of the applicant’s treating psychologist, Dr. Little, who has more intimate knowledge of the applicant’s treatment needs, over Dr. Kiss. Moreover, Dr. Kiss’s opinion supports more weight being placed upon Dr. Little’s opinion as in his November 20, 2019 report, Dr. Kiss concluded that the specific type of psychotherapeutic intervention should be determined by an appropriately trained and experienced psychologist, which would be Dr. Little. Despite Dr. Little (who is a psychologist) recommended the proposed services, the respondent maintained its denial.
12Contrary to the respondent’s position that social work treatment has not been effective to date, Dr. Little’s report states otherwise. In her report, Dr. Little noted that she had spoken to Ms. Ross on two separate occasions about the previous social work treatment. During discussions, Ms. Ross advised Dr. Little that the previous social work treatment had resulted in the applicant developing coping skills and a good rapport was built between them. Accordingly, Dr. Little opined that a variety of other forms of treatment was required to treat the applicant’s psychological impairments, beyond psychotherapy.
13Subsequently, on January 31, 2022, Dr. Little provided a recommendation letter to support this disputed OCF-18. Particularly, Dr. Little recommended that in comparison to the treatment she provides, Ms. Ross could assist the applicant with: community involvement, practical parenting support, and coping with obstacles with engaging in social and work-life activities.
14Second, I am not persuaded by the respondent’s position that social work treatment is not reasonable and necessary because it will provide duplicative services. I agree with the respondent that the proposed social work services will have some overlapping with the psychotherapy being provided by Dr. Little. However, Dr. Little has recommended the proposed services as the current psychotherapy treatment is not sufficient on its own to treat the applicant. I accept this opinion.
15Furthermore, I disagree with the respondent that the proposed social work services are duplication of the previously denied occupational therapy (OT) services, which the Tribunal determined in a previous decision as not being reasonable and necessary.
16The applicant previously filed a Tribunal application, dated September 11, 2020, for the same accident. The previous application pertained to OCF-18s for occupational therapy services, rehabilitation support worker services, vision therapy, speech language pathology sessions, moving expenses, occupational therapy assessment, occupational therapy treatment and devices, and physiotherapy services. In its decision reported at Foster v Co-operators General Insurance Company, 2021 CanLII 134960 (ON LAT) (“Previous Decision”), the Tribunal determined that none of the OCF-18s in that matter were reasonable and necessary.
17Significantly, in the Previous Decision, the Tribunal determined that the proposed OT/rehabilitation support work services were not reasonable and necessary because the applicant’s issues related more to her psychological injury, rather than a neurocognitive impairment. Moreover, at paragraph [117] of the Previous Decision, the Tribunal determined that the applicant’s injuries do not require further physical therapy until her psychological symptoms have been fully investigated. I agree with the applicant, that Ms. Ross will be providing services to treat psychological conditions, and not physical conditions.
18The OT/rehabilitation support work services that were before the Tribunal in its Previous Decision pertained to treating the applicant’s neurocognitive impairment. In comparison, the disputed OCF-18 before me is to treat the applicant’s psychological conditions. As such, I am not persuaded by the respondent’s arguments that the proposed social work services are a duplication of the services that were denied in the Previous Decision, as one was to treat neurocognitive conditions, and the other is for psychological conditions.
19Finally, I disagree with the respondent’s submission that the applicant’s social isolation is not directly related to the accident. In the Previous Decision, specifically at paragraph [102], the Tribunal determined that the applicant had not demonstrated her alleged impairments with caring for her child were as a result of the accident. However, at paragraph [101], the Tribunal noted that it preferred the evidence of the respondent and agreed that the applicant’s impairments are psychological rather than neurocognitive/physical impairments. Moreover, from paragraphs [96] to [100], it was noted by the Tribunal that the applicant was claiming these services due to difficulty with childcare from a physical/neurocognitive perspective, not psychological. Therefore, I disagree with the respondent that the Previous Decision supports its position, as once again the Tribunal recognized the applicant’s psychological impairments.
20In conclusion, I find that the applicant has established that the proposed social work services are reasonable and necessary.
The applicant is not entitled to the balance of the September 19, 2022 OCF-18 of $3,591.04 for vestibular physiotherapy
21I find that the applicant is not entitled to the OCF-18 with a remaining balance of $3,591.04 for vestibular physiotherapy.
22The applicant submits that the goals of the OCF-18 are to: reduce pain, increase strength, and range of motion, and enable her to return to her activities of normal living. The applicant further argues that this OCF-18 was recommended by her family physician, Dr. L. Komorowski. To support her position, she relies upon the referral for physiotherapy from Dr. Komorowski, progress note of Lisa Souliere, physiotherapist, dated December 12, 2019, and s. 25 reports of Dr. Erin Warriner, neuropsychologist, Dr. Keith Sequeira physiatrist, Dr. Paul Cooper, neurologist, dated January 29, 2022, December 10, 2021, and May 16, 2022.
23In response, the respondent argues that the doctrine of res judicata applies, and the applicant is pursuing a collateral attack. This argument is premised on the basis that the Tribunal in the Previous Decision determined an identical treatment plan was not reasonable and necessary.
24In her reply submissions, the applicant argues that the respondent, as her insurer, has a duty to fairly assess the evidence before it and, as such, further treatment cannot be res judicata. She argues that she has new evidence from Drs. Komorowski, Sequeira, Warriner, and Cooper, which were not before the Tribunal previously. She takes the position that this new evidence demonstrates that the proposed vestibular physiotherapy is reasonable and necessary.
25The doctrine of res judicata prevents a party from relitigating an issue that has already been decided. Four preconditions must be established before the adjudicator can determine whether to exercise discretion to apply res judicata, as set out by the Supreme Court of Canada in Danyluk v. Ainsworth Technologies Inc., 2001 SCC 44 at paragraph 18:
i. The parties must be the same in both actions;
ii. The prior claim must be within the jurisdiction of the Court/Tribunal;
iii. The prior adjudication must have been on the merits; and
iv. The prior decision must have been a final judgement.
26I am satisfied that these preconditions have been met and find that the doctrine of res judicata applies to this OCF-18. The applicant in the Previous Decision and in the present case are the same. The prior claim is within the Tribunal’s jurisdiction. The Previous Decision was determined on the merits, and it was a final decision. The applicant has not sought a reconsideration or appeal of the Previous Decision. It is unclear from the applicant’s submissions whether she is arguing that res judicata should be waived. However, the applicant has argued that she has new evidence since the Previous Decision, I will now turn to this.
27As noted in Toronto (City) v. CUPE Local 79, 2003 SCC 63 at paragraph 52, res judicata can be waived in the following situations:
i. The first proceeding is tainted by fraud or dishonesty;
ii. Fresh, new, evidence is submitted that was previously unavailable that would conclusively impeach the original results; or
iii. When fairness dictates that the original result should not be binding in the new context.
28I do not need to determine if the new evidence was previously available because it would not impeach the original results. I find that the new evidence submitted by the applicant would not conclusively impeach the original results such that res judicata has been waived regarding this OCF-18.
29First, Drs. Sequeira, Warriner, and Cooper, did not address or rebut the conclusion of the s. 44 assessors, Drs. Kiss, Khaled, and Dimitrakoudis, whose opinions persuaded the Tribunal in the Previous Decision. Despite reviewing the reports, none of the assessors addressed the concerns of the applicant being overtreated and that their opinions that the applicant’s residual impairments were predominantly psychological at that time. I place little weight on these reports because the assessors did not address the s. 44 reports, nor did they provide any reasons or objective opinion as to why they disagreed with the report, and the recommendations.
30Second, none of the assessors, specifically recommended the proposed services. I disagree with the applicant that Dr. Warriner recommended vestibular physiotherapy. Instead, Dr. Warriner recommended that further vestibular and ocular-motor investigations and treatment should be pursued. However, he did not specify which type of treatment was required.
31Finally, I acknowledge that Dr. Komorowski recommended vestibular physiotherapy. However, it is unclear whether he was provided with the s. 44 reports in which the doctors opined that the applicant has already received significant treatment, which has resulted in iatrogenic influence, i.e., being overtreated. Nor did Dr. Komorowski provide a rationale of how vestibular physiotherapy would improve the applicant’s head injury, especially, since she has received this treatment already.
32I am not satisfied that this new evidence shows a material change in the applicant’s medical condition since the previous Tribunal hearing. As such, the applicant has not presented new evidence that would conclusively impeach the original results to warrant a waiver of res judicata, I find that the applicant remains bound by the previous determination by the Tribunal in the Previous Decision.
The applicant is not entitled to the June 23, 2022 OCF-18 in the amount of $7,411.83 for Case Management Services and a Cefaly Device
33I find that the applicant has not met her evidentiary burden to establish that the proposed OCF-18 for case management services and a Cefaly Device is reasonable and necessary.
34The applicant submits that she has purchased optional accident benefits and, as such, is entitled to case management services without a catastrophic designation. She further argues that she already retained the services of Ms. Susan Waymouth, rehabilitation consultant, to facilitate and coordinate her rehabilitation treatments. Moreover, the applicant submits that she has ongoing difficulties with memory, poor attention, concentration, and has an impaired capacity to manage her time and schedule. Lastly, the applicant argues that a Cefaly Device was recommended by her treating neurologist, Dr. Ana Cartagena.
35In response, the respondent submits that at the time these services were proposed, the only ongoing treatment was psychological counselling with Dr. Little and seeing Dr. Komorowski. Furthermore, it argues that Dr. Komorowski attempted to refer the applicant to a chronic pain management program without the assistance of the case manager. As such, the respondent submits the proposed services are neither reasonable nor necessary. The respondent also submits that it is not liable to pay for the Cefaly Device under s. 15, as this device is not listed under s. 15(1)(a) to (g) of the Schedule and it does not agree that this device is essential.
a) Case Management Services
36During the time period of the OCF-18, there is no corroborating medical evidence that supports or recommends the case management services proposed. I acknowledge that the applicant self-reports that she has difficulty keeping track of medical appointments and medications. However, she has not referred me to a medical opinion that substantiates she requires these services as a result. Other than the treatment plan itself, the applicant has not pointed to other evidence that links the need for the case manager to her accident-related injuries. Even the case manager does not provide a rationale or an explanation of why the proposed services are required and for what accident-related impairments. It is well-settled that OCF-18s alone are not sufficient evidence of the reasonableness and necessity of a plan. Rather, additional contemporaneous and compelling medical evidence is required to support the request.
37The applicant has not referred me to evidence that is contemporaneous to this treatment that corroborates the need for case management services at the time the OCF-18 was submitted. For instance, the only treatment that the applicant was receiving at this time was from Dr. Little, and she has not directed me to evidence that supports that she required Ms. Waymouth’s assistance with those appointments.
38Aside from one visit on February 7, 2023, the applicant attended Dr. Komorowski’s office by herself on August 5, 2022, and October 5, 2022, after the OCF-18 for case management services was submitted. During the August 5, 2022 and October 5, 2022 visits, there is no reference in the clinical notes and records to whether the applicant struggled with attending the appointment, or with her medication.
39Substantially, on February 7, 2023, Ms. Waymouth did not assist Dr. Komorowski in referring the applicant to a chronic pain management program. Rather, Dr. Komorowski completed the referral forms without any assistance. Aside, from completing a reiteration letter of this one visit, the applicant has not proffered evidence that Ms. Waymouth has coordinated any referrals or managed the applicant’s case.
40In short, I find that the evidence is lacking to support that the proposed case management services are reasonable and necessary.
41Further, I am not persuaded by the authority cited by the applicant. In Gibson v. Intact Insurance Company, 2023 CanLII 34458 (ON LAT) (Gibson), the Tribunal determined that it was an error of law to interpret objective medical evidence as requiring a treating physician to specifically recommended the proposed services. In the matter before me, the applicant has not directed me to anyone who recommended the services, treating practitioner or not. Therefore, the decision in Gibson is distinguishable on the facts and, in any event, I am not bound by other Tribunal decisions.
42I also note that the respondent made submissions with respect to most of the case management services being incurred prior to an OCF-18 being submitted, and therefore not being payable under s. 38(2). While I acknowledge these submissions, given my findings above, it is unnecessary to consider this, as I have already determined that the applicant has not established the proposed OCF-18 is reasonable and necessary.
b) The Cefaly Device
43Section 15.(1) of the Schedule states: 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 for:
a) medical, surgical, dental, optometric, hospital, nursing, ambulance, audiometric and speech-language pathology services;
b) chiropractic, psychological, occupational therapy and physiotherapy services;
c) medication;
d) prescription eyewear;
e) dentures and other dental devices;
f) hearing aids, wheelchairs or other mobility devices, prostheses, orthotics and other assistive devices;
g) transportation for the insured person to and from treatment sessions, including transportation for an aide or attendant; and
h) 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. O. Reg. 34/10, s. 15 (1); . O. Reg. 34/10, s. 15 (1); O. Reg. 251/15, s. 5.
44The applicant submits that the Cefaly Device, was recommended by her treating neurologist, Dr. Ana Cartagena, and can be worn externally on her forehead to deliver external trigeminal nerve stimulation, to treat her post-traumatic migraines.
45The respondent submits that it is not liable to pay for the Cefaly device under s. 15(1), as this device is not listed under s. 15(1)(a) to (g), and it does not agree that this device is essential.
46Now turning to whether the Cefaly device is payable, I find that it is not. This device is not listed under s. 15(1)(a) to (g), and as such, it is only payable under s. 15(1)(h) if the insurer agrees that it is essential for treatment of the insured person. In this regard, the respondent contests that the device is essential for treatment. To summarize, the Cefaly Device does not fall within the meaning of a medical and rehabilitation benefit under s. 15(1), and the respondent disagrees it is essential, thus the device is not payable.
The applicant is entitled to all of the OCF-6s for cannabis
47I find that the applicant has demonstrated the OCF-6s for prescribed cannabis are reasonable and necessary.
48There are four OCF-6s in dispute for expenses for dried cannabis, CBD oil, and CBD/THC oral spray.
49The applicant argues that the cannabis has been prescribed by Dr. Michael Hart, family physician, and she purchased the prescribed cannabis. She argues that these expenses are reasonable and necessary because it improves her sleep, reduces pain/headaches, anxiety, and increases her ability to engage more in her daily activities.
50The respondent argues that the applicant has not established the cannabis is reasonable and necessary. It relies upon the s. 44 reports of Dr. Mohamed Khaled, physician, and Dr. Todd Levy, physician, dated November 18, 2019, and December 9, 2021. It argues that Dr. Levy did not recommend the use of cannabis while the applicant is breastfeeding and that Dr. Khaled did not find cannabis use to be reasonable and necessary based on the Guidelines from the College of Family Physicians of Canada.
51The applicant cites the authority of 17-006850 v. Royal Sun Alliance Insurance, 2018 CanLII 132555 (ON LAT), in which the Tribunal determined that three factors need to be met in order for a respondent to be liable to pay a prescription medicine. These three factors include:
i. The motor vehicle accident caused the impairment that necessitates the prescription medication;
ii. The prescription medication is reasonable and necessary; and
iii. A regulated health professional provides the prescription.
52While I am not bound by 17-006850 v. Royal Sun Alliance Insurance, I am persuaded by these three factors and have applied them to the matter before me. The parties do not dispute that the factor (i) and (iii) are met here. Instead, the dispute arises between the parties over whether the cannabis expenses are reasonable and necessary. I find that the applicant has established on a balance of probabilities that the cannabis expenses are reasonable and necessary.
53First, the evidence indicates that the applicant has sustained benefits from the use of cannabis. For instance, on March 11, 2020 and June 1, 2021, Dr. Hart noted in his records that the applicant had advised that cannabis has been helpful with her headaches, brain fog, and general condition, better sleeping, and resulted in less pain overall. It was noted that cannabis provided better pain relief, and as a result, the applicant was able to “do more things.” As such, Dr. Hart prescribed further cannabis.
54Significantly, in the March 2, 2021 clinical note and record (CNR) entry most contemporaneous to the submission of the OCF-6s, Dr. Hart noted that when the applicant stopped the cannabis due to being pregnant, her headaches, insomnia, and pain had returned, and her anxiety became much worst. As such, he prescribed more cannabis to the applicant.
55Pain relief is a legitimate goal of treatment, and the treatment was providing relief to the applicant which allowed her to function, as indicated in Dr. Hart’s records. As such, I find this establishes that the proposed expenses are reasonable and necessary. Moreover, as shown in the March 2, 2021 CNR entry, when the applicant stopped using cannabis, she reported that her symptoms returned and became worst.
56Second, I am not persuaded by the respondent’s position that the cannabis is not reasonable and necessary because Drs. Khalid and Levy have opined that chronic pain and psychological impairments are not effectively managed by cannabis. I acknowledge that both doctors cited research for several sources, including the Guidelines from the College of Family Physicians of Canada, however I place more weight on the opinion of Dr. Hart, who is the applicant’s treating physician, and has more intimate knowledge of the applicant’s treatment needs. Moreover, Dr. Hart has encouraged that the applicant be supported financially with her cannabis use.
57Indeed, on July 9, 2021 Dr. Hart provided a detailed letter where he addressed the concerns raised by both Drs. Levy and Khalid, which is the lack of research supporting the effectiveness of cannabis treatment for chronic pain and psychological conditions. Dr. Hart noted that the applicant has continued to use medical cannabis to help alleviate ongoing symptoms of nausea, anxiety, headaches and poor sleep, and continuously reports that this helps to reduce her symptoms and improve her overall quality of life. Notably, Dr. Hart noted that while medical cannabis is not an approved treatment for post-concussion syndrome, Health Canada has acknowledged that there is some evidence to support the efficacy of cannabinoids treating chronic pain, anxiety, and sleep disturbances.
58Crucially, Dr. Hart noted that if the applicant was not using cannabis, she would have to resort to other pharmaceuticals that have a high risk of adverse effect, meanwhile cannabis has a lower risk. Ultimately, Dr. Hart concluded that the applicant preferred to continue using medical cannabis for pain and symptom management as it had proved beneficial and well tolerated by her, with no evidence of adverse effects. As such, Dr. Hart encouraged that the applicant should be supported financially for her medical cannabis.
59I place more weight on Dr. Hart’s opinion, as he is the applicant’s treating physician, and is basing his opinion not only on the research, but also on his firsthand knowledge of the applicant’s improvement.
60I acknowledge the respondent’s position that the applicant has not commenced chronic pain treatment, nor Botox or nerve block injections for her headaches as recommended by Drs. Cartagena, Cooper, and Sequeira. The respondent’s position is that because these treatments have not been commenced, the OCF-6s for cannabis are not reasonable and necessary.
61However, I agree with the applicant that the Tribunal must consider that the choice of modality of treatment is that of the insured person and her health practitioner. To support this argument, the applicant referred me to the authority of F.J. v Intact Insurance Company, 2020 CanLII 34495 (ON LAT) (F.J.) where the Tribunal noted that the Tribunal must consider that the choice of modality of treatment is that of the insured person and her health care practitioner. Also, the Tribunal determined that “the applicant knows her body, and she knows what helps and reduces her pain, anxiety and other impairments.”
62While I am not bound by F.J., I concur with Adjudicator Paluch that the choice of modality of treatment is that of the insured person and her health care practitioner. Here, the applicant has reported improvement to her pain, anxiety, headaches, and sleep, and Dr. Hart has not only encouraged her to continue but has also prescribed the cannabis. Thus, I disagree with the respondent’s position that the applicant has to pursue other treatment modalities in order to make this one reasonable and necessary, as she is already receiving benefit from this treatment.
63I further acknowledge the respondent’s position that the applicant’s family physician, Dr. Komorowski is not involved in the prescription or monitoring of the use of cannabis. However, as noted above, the applicant has been seeing Dr. Hart, who is also a family physician, and is responsible for the prescription and monitoring of the use of her cannabis.
64Finally, I note the respondent’s submissions that Drs. Sequeira, and Levy raised concerns of using THC while breastfeeding. In his report, dated December 10, 2021, Dr. Sequeira noted that while medical cannabis is appropriate for the applicant, medical advice should be sought regarding its usage while breastfeeding. Also, Dr. Levy in his report, dated December 9, 2021, concluded that he would not recommend cannabis during breastfeeding. However, the applicant, is under the care of Dr. Hart, who is responsible for monitoring her cannabis use, and I have not been referred to any evidence where he recommended that cannabis not be used while the applicant was breastfeeding.
65For all these reasons, I find that the applicant has demonstrated that the OCF-6s are reasonable and necessary.
The applicant is entitled to interest for the OCF-18 for social work services and the OCF-6s
66Pursuant to s. 51 of the Schedule, the applicant is entitled to interest for the OCF-18 proposing social work services, and the OCF-6s.
ORDER
67For the reasons outlined above, I find that:
i. The applicant is entitled to the November 1, 2021 OCF-18 in the amount of $2,700.00 for social work services plus interest for this OCF-18 in accordance with s. 51 of the Schedule;
ii. The applicant is not entitled to a remaining balance of $3,591.04 for the September 19, 2022 OCF-18 for vestibular physiotherapy;
iii. The applicant is not entitled to the June 23, 2022 OCF-18 in the amount of $7,411.83 for Case Management Services and a Cefaly Device; and
iv. The applicant is entitled to the OCF-6s for cannabis plus interest in accordance with s. 51 of the Schedule.
Released: September 26, 2024
Tanjoyt Deol
Adjudicator