Licence Appeal Tribunal File Number: 24-001144/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:
Lai Ching Kong
Applicant
and
Pembridge Insurance Company
Respondent
DECISION
ADJUDICATOR:
Melanie Malach
APPEARANCES:
For the Applicant:
Rakesh Sharma, Counsel
For the Respondent:
Andrew Cottreau, Counsel
HEARD:
By way of written submissions
OVERVIEW
1Lai Ching Kong, the applicant, was involved in an automobile accident on December 8, 2022, 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, Pembridge 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 a non-earner benefit of $184.00 per week from January 5, 2023 to December 8, 2024?
ii. Is the applicant entitled to $4,217.20 for chiropractic services, proposed by U Heal Rehab Centre in a treatment plan dated April 18, 2023?
iii. Is the applicant entitled to $523.60 ($3,701.74 less $3,178.14 approved) for psychological services proposed by Somatic Assessments in a treatment plan dated February 5, 2024?
iv. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
v. Is the applicant entitled to interest on any overdue payment of benefits?
3The Case Conference Report and Order (“CCRO”), dated July 5, 2024, lists issue 4 as, “Is the applicant entitled to $21.51 for medication, submitted on a claim form (OCF-6) dated November 14, 2023?” The applicant in her submissions has withdrawn this issue.
RESULT
4I find that the applicant is not entitled to a non-earner benefit of $185.00 per week from January 5, 2023 to December 8. 2024.
5I find that the applicant is not entitled to the treatment plan for chiropractic services or the unapproved balance of the treatment plan for psychological services.
6I find that the applicant is not entitled to interest and the respondent is not required to pay an award.
PROCEDURAL ISSUE
Section 54 of the Schedule
7The applicant in her reply submissions refers to s. 54 of the Schedule. She submits that she does not have the onus to disprove the case made out by the respondent that is not based on the denial reasons served upon the applicant under s. 54 of the Schedule.
8Section 54 of the Schedule provides that if an insurer refuses to pay a benefit or reduces the amount of a benefit that a person is receiving, the insurer shall provide the person with a written notice advising the person of his or her right to dispute the refusal or reduction.
9I find that the applicant is attempting to assert that the respondent is not allowed to make new submissions in this hearing, that were not specifically noted in the respondent’s denial letters of the benefits in dispute. The applicant has provided no authority to support this interpretation, nor do I find that it is remotely accurate based on a plain reading of the section. There is no indication in s. 54 of the Schedule that the respondent in a hearing before the Tribunal can only make submissions based on its denial letters or that it is permitted to make new submissions. Rather, s. 54 simply requires an insurer provide a clear and unequivocal denial letter and advise the insured of their right to dispute the refusal. It says nothing about the respondent’s right to make submissions at a hearing or that its submissions are confined to those contained in a denial letter.
10I find that the respondent has complied with s. 54 of the Schedule and provided the applicant with clear and unequivocal denials. It further advised the applicant of her right to dispute the refusal within these denials, as required by s. 54. I further find that the respondent is entitled to present its case as it sees fit, including submissions on its position and responses to the applicant’s submissions and evidence.
ANALYSIS
Entitlement to a Non-Earner Benefit (“NEB”)
11I find that the applicant is not entitled to a NEB of $185.00 per week from January 5, 2023 to December 8, 2024. I find that she has not established, on a balance of probabilities, that she suffers a complete inability to carry on a normal life as a result of the accident.
12Section 12(1) of the Schedule provides that an insurer shall pay a NEB to an insured person who sustains an impairment as a result of the accident, if the insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident. Section 3(7)(a) of the Schedule defines “a complete inability to carry on a normal life” as “an impairment that continuously prevents the person from engaging in substantially all of the activities in which the person ordinarily engaged before the accident”.
13The Court of Appeal set out the guiding principles for NEB entitlement in Heath v. Economical Insurance Company, 2009 ONCA 391 (“Heath”), which generally focuses on a comparison of the applicant’s pre- and post-accident activities.
14For the applicant to prove that she sustained injuries that continuously prevent her from engaging in substantially all of her pre-accident activities, she must present a thorough analysis and comparison of activities that she could not do before and after the accident. The applicant must first identify the activities in which she used to engage, along with their frequency and importance.
15Section 36(2) of the Schedule provides that an insured’s application for a specified benefit shall include a completed disability certificate (“OCF-3”) along with her application under s. 32 of the Schedule.
16Section 36(4) of the Schedule provides that within ten business days after the insurer receives an application and a completed OCF-3, the insurer shall,
a. Pay the specified benefit;
b. Give the applicant a notice explaining the medical and any other reasons why the insurer does not believe that the applicant is entitled to the specified benefit and, if the insurer requires an examination under section 44 relating to the specified benefit, advising the applicant of the requirement for an examination; or
c. Send a request to the applicant under subsection 33(1) or (2).
17Section 36(5) of the Schedule further states that if an insurer sends a request to the applicant under subsection 33(1) or (2), the insurer shall, within ten business days after the applicant complies with the request, pay the specified benefit or give the applicant a notice described in clause 36(4)(b). If the insurer fails to comply with either s. 36(4) or s. 36(5), the insurer must pay the specific benefit for the period starting on the day the insurer received the application and the completed OCF-3 until it provides notice in accordance with s. 36(4)(b).
18The applicant faxed her Application for Accident Benefits (“OCF-1”) dated December 20, 2022 and her Election of Benefits form (“OCF-10”), dated December 20, 2022 electing NEBs, to the respondent on January 3, 2023.
19On December 29, 2022, the applicant’s OCF-3, dated December 21, 2022, was faxed to the respondent, indicating that she suffers a complete inability to carry on a normal life.
20In response, the respondent provided an Explanation of Benefits (“EOB”) to the applicant dated January 13, 2023. The EOB requests information pursuant to s. 36(4)(c) and s. 33(1) of the Schedule, to determine the applicant’s eligibility to a NEB, to be complied with by February 3, 2023. The respondent followed up on its s. 33 requests in further EOBs dated April 24, 2023 and May 24, 2023.
21In November 2023, the applicant provided the Clinical Notes and Records (“CNRs”) of her family doctor. In response, the respondent provided the applicant with a Notice of Examination (“NOE”) dated December 12, 2023, advising of the s. 44 assessments scheduled with Dr. Abdul-Wahab Khan, physiatrist, on January 11, 2024, Dr. Cheryl Bradbury, psychologist, on January 15, 2024, and Elana Korman, occupational therapist, on February 29, 2024, to assess her entitlement to a NEB.
22By EOB dated April 5, 2024, the respondent advised the applicant that she was not entitled to a NEB based on the s. 44 reports of Dr. Khan, Dr. Bradbury and Ms. Korman, dated March 22, 2024. It advised the applicant that in accordance with s. 36 of the Schedule, she is not entitled to NEBs and her NEB will be stopped effective April 5, 2024.
23The applicant submits that under s. 36(4) of the Schedule, subsection (a) states to pay the specified benefit. There is no “or” between subsection (a) and subsection (b). There is an “or” between subsection (b) and (c). Therefore, section (a) and (b) and subsection (a) (c) are required to be read in continuation as the objective of the consumer protection nature of the Schedule is to provide access to benefits. The applicant submits that reading subsection (a) and (c) together implies that the respondent must commence the payment of benefits while requesting information under s. 33 and may only suspend payment for the period of non-compliance.
24The applicant submits that she submitted a completed OCF-3 to the respondent stating that she was eligible for a NEB. She submits that the respondent was required to commence the payment of NEBs within ten days of receipt of the OCF-3 under s. 36(4)(a) of the Schedule and pay her a NEB until it obtained the information under s. 33 of the Schedule by invoking s. 36(4)(c).
25The applicant submits that she was never put on notice of the date of suspension of her NEB for her non-compliance of providing the requested documentation. Therefore, she continued to be entitled to a NEB on the basis of the OCF-3, for the period December 8, 2023 to April 4, 2024.
26The applicant further submits that for the period from April 5, 2024 to December 8, 2024, she is entitled to a NEB because the respondent’s request for documents under s. 33 of the Schedule was not reasonably required to assist the respondent in determining the applicant’s entitlement to the benefit. In addition, the respondent’s action of scheduling Insurer Examinations (“IEs”) is in contravention of the provisions of s. 36(4) that imposes a limit of ten days’ notice to the applicant of the insurer’s intent to schedule IEs. The applicant further submits that the IE reports are statutorily deficient as the insurer assessors failed to make an analysis of their injury diagnosis to the legal test of complete inability to carry out a normal life and what complete inability means under s. 3 of the Schedule.
27The respondent submits that on January 13, 2023, it provided a response to the applicant’s application for NEBs in compliance with s. 36(4)(c) of the Schedule and requested information pursuant to s. 33(1) of the Schedule, that to date has still not been provided. The respondent submits that the applicant’s submission that it was required to pay the applicant a NEB while it waited to receive the information requested under s. 33(1) of the Schedule is wrong. It submits that the applicant has not provided any case law in support of this assertion. The respondent argues that an insurer is relieved of the obligation to pay a NEB during any period of s. 33(1) non-compliance. It relies upon the Tribunal decision in Shaikh v. Economical Insurance Company, 2023 CanLII 2690 (ON LAT) (“Shaikh”).
28With respect to the applicant’s assertion that the respondent’s request for documents under s. 33(1) is not reasonably required, the respondent argues that an applicant is not entitled to a NEB when there is a failure to deliver medical records pursuant to s. 33(1). It submits that the applicant did not deliver the release forms for it to obtain the family doctor CNRs or the OHIP summary and she did not provide the respective documents themselves until November 2023 and August 2024, well after the substantive denial date. The applicant submits that upon receipt of the family doctor CNRs in November 2023, it then proceeded to arrange s. 44 assessments.
29The respondent further relies on the opinions of the IE assessors in the reports dated March 22, 2024, that determined that the applicant was not entitled to a NEB. It further submits that there are no contemporaneous records challenging the conclusions made by the IE assessors that the applicant does not suffer a complete inability to carry on a normal life.
The applicant is not entitled to a NEB
30I do not agree with the applicant’s interpretation of s. 36(4) of the Schedule that subsections (a) and (c) are to be read continuously. I find that the applicant has provided her own interpretation of this section without providing the Tribunal with any authority or case law supporting same. I find that under s. 36(4), the respondent is given three options: agree that the applicant is entitled to the benefit and pay the specified benefit, disagree that the applicant is entitled and arrange a s. 44 assessment or request additional documents pursuant to s. 33(1) of the Schedule to assist with the determination. I do not interpret s. 36(4) as meaning that the respondent is required to commence payment of a NEB until it receives the s. 33(1) information. The respondent received the OCF-3 and pursuant to s. 36(4)(c) requested further information pursuant to s. 33(1). The applicant did not comply with the s. 33(1) requests and therefore the respondent was not required to pay a NEB until the applicant complied.
31I find that the respondent in response to the OCF-3, met the requirements of s. 36(4)(c) of the Schedule when it requested further information pursuant to s. 33(1) of the Schedule in the EOB dated January 13, 2023. The respondent was not required to pay a NEB until the applicant complied. I find that to date, there is no evidence that the applicant has complied with all of the s. 33(1) requests made by the respondent. In addition, the applicant has not provided an explanation for her non-compliance with the s. 33(1) requests. I further find that the respondent’s EOB specifically requested that the s. 33(1) requests be provided by February 3, 2023, which is sufficient notice of the date of suspension if she did not comply with the requests. Finally, I find that the medical documentation requested pursuant to s. 33(1) was reasonable to assess the applicant’s entitlement to a NEB to determine her ongoing pain complaints and functional limitations. The applicant has not provided sufficient evidence or submissions to support that these requests were not reasonable.
32I therefore find that the applicant is not entitled to a NEB for the period from December 8, 2023 until April 4, 2024 due to her failure to comply with the respondents s. 33(1) requests.
33I find that for the period from April 5, 2024 to December 8, 2024, the applicant is not entitled to a NEB. I give weight to the conclusions of the IE assessors which found that the applicant did not suffer a complete inability to carry on a normal life based on the physical assessments and testing administered by the assessors. I find that the applicant has not directed the Tribunal to any medical evidence to support the applicant’s substantive entitlement to a NEB or to refute the findings in the IE reports. While the applicant has referred to the case of Heath in her submissions, she has not provided any submissions or evidence with respect to the guiding principles set out in the decision and has therefore not met the test for entitlement. I find that it is the applicant’s onus to meet this test, not the respondent’s onus to disprove entitlement.
34For the reasons outlined above, I find that the applicant has not proven on a balance of probabilities that she is entitled to a NEB for the period from January 5, 2023 to December 8, 2024.
Entitlement to Medical and Rehabilitation Benefits
35To receive payment for medical and rehabilitation benefits under sections 15 and 16 of the Schedule, the applicant has the onus of proving 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 the overall costs of achieving them are reasonable.
36Section 38(8) of the Schedule provides that an insurer shall respond to a treatment and assessment plan within 10 days of receiving it by identifying the goods and services, assessments and examinations described in the plan that the insurer does and does not agree to pay for. The insurer must also provide medical and all other reasons why it has determined that the treatment and assessment plan is not reasonable and necessary.
37If an insurer fails to comply with s. 38(8), the Schedule sets out two consequences under s. 38(11). First, an insurer who fails to provide the insured with an adequate notice of the reasons for its denial is prohibited by s. 38(11)(1) from taking the position that the insured person has an impairment to which the MIG applies. Second, s. 38(11)(2) provides that if an insurer fails to provide proper notice of the reasons for its denial it must pay for all incurred goods, services, assessments and examinations described in the treatment and assessment plan that related to the period starting on the 11th business day after the day the insurer received the applicant and ending on the day the insurer gives notice as described in s. 38(8)
The applicant is not entitled to the treatment plan for chiropractic services
38The applicant claims entitlement to $4,217.20 for chiropractic services, proposed by UHeal Rehab Centre, in a treatment plan dated April 18, 2023. The treatment plan recommends the following services:
i. Assessment, total body: $200.00
ii. Documentation, support activity: $190.00
iii. 16 sessions of chiropractic treatment: $1,804.96
iv. 16 sessions of exercise: $902.56
v. 16 sessions of acupuncture: $799.68
vi. 16 sessions of provider travel time: $320.00
39The goals of the treatment plan are listed as pain reduction, increase range of motion, increase in strength, reduce swelling and inflammation, and increase neuro-muscular endurance.
40The respondent by EOB dated May 2, 2023, denied the treatment plan. It advised the applicant that:
To date, we have not been provided with any compelling medical evidence documented by your family/attending physician to support that your pre-existing medical condition would prevent you from achieving maximum medical recovery within the minor injury framework. Therefore, your claim remains subject to the Medical and Rehabilitation limit of $3,500.00 as per Section 18(1) of the Statutory Accident Benefits Schedule (SABS). If you or your health practitioner has any additional medical evidence that has not been previously submitted, please forward it for consideration.
41The applicant submits that the respondent’s denial letter is in contravention of s. 38(8) of the Schedule and it is a boiler plate response, as it ignored the information in part 4 of the treatment plan which states that treatment is sought as the injuries sustained from the accident were predominantly not minor injuries and the box for exacerbation of pre-existing injury has been left blank. The applicant submits that the requirement of compelling evidence documented before the accident applies only in the case where the applicant seeks treatment payable other than MIG based on exacerbation of a pre-existing medical condition. The applicant therefore submits that the reason for the denial is incorrect and not applicable to the information in the treatment plan.
42The applicant further submits that the respondent’s request for more documents is in non-compliance with s. 38(8) of the Schedule, because the section only permits the respondent to provide medical and other reasons where the respondent does not consider the treatment plan reasonable and necessary. The applicant relies upon the decision in Hedley v. Aviva, 2019 ONSC 5318, where the court held,
Where reasons are required, they must be meaningful in order to permit the insured to decide whether or not to challenge the insurer determination. Mere boiler plate statements do not provide a rationale to which an insured can respond. In essence, such statements constitute no reasons at all.
43The applicant also submits that the respondent again denied the treatment plan by letter dated April 5, 2024, based on an IE report prepared by Dr. Wahab Khan, physiatrist, dated March 22, 2024. The applicant submits that the respondent’s initial denial letter dated May 2, 2023, does not put the applicant on notice about its intent to schedule an IE. Pursuant to s. 38(10) of the Schedule, the notice to schedule an IE is subject to the ten-day notice period under s. 38(8), which the respondent did not comply with. The applicant therefore argues that the IE report of Dr. Khan, dated March 22, 2024, contravenes s. 38(8) and s. 38(11) of the Schedule, and is inadmissible under s. 15(2) of the Statutory Powers Procedure Act (“SPPA”). The applicant requests that the report be excluded from the evidence considered by the Tribunal.
44In the alternative, the applicant submits that the report of Dr. Khan is statutorily deficient as it fails to make an evaluation of the in-person examination findings with the information provided in the treatment plan. The report also does not consist of an analysis as to what the maximal recovery level is based on the diagnosis of injuries and how that level has been achieved.
45The respondent submits that the disputed treatment plan was denied by EOB dated May 2, 2023, based on the MIG. It submits that at the time of the denial, the applicant was being held within the MIG and the applicant had failed to deliver the medical records requested pursuant to s. 33(1) of the Schedule. The respondent states that when it received the family doctor records from the applicant, it highlighted in its NOE dated December 12, 2023, that “…In addition, the clinical notes and records do not support the treatment requested by Uheal for $4,217.20. The clinical notes and records do not mention physical issues, predominantly mention psychological issues.”
46The respondent states that the applicant was removed from the MIG following the IE assessments for an adjustment disorder diagnosis, but the physiatry IE assessment performed by Dr. Khan concluded that the disputed treatment plan for chiropractic services was not reasonable and necessary. By EOB dated April 5, 2024, the respondent advised the applicant that the treatment plan for chiropractic services was denied based on Dr. Khan’s IE report.
47The respondent submits that for a treatment plan to be found reasonable and necessary, it is not sufficient that the applicant personally believes that the treatment is necessary, but rather objective medical evidence must be considered. The respondent submits that there is no objective medical evidence supporting the applicant’s position. While the applicant relies entirely on treatment plans to support her case, the treatment plans are not evidence to establish entitlement to benefits as determined in the Tribunal decision in Corpuz v. Aviva General Insurance, 2021 CanLII 18909 (ON LAT) (“Corpuz”). The respondent submits that the applicant’s submissions attempt to criticize the respondent’s denial instead of focusing on meeting her own onus.
48I find that the applicant has not provided any submissions or evidence to support that the treatment plan in dispute is reasonable and necessary. I agree with the respondent that the focus of the applicant’s submissions is on the procedural issues with the respondent’s EOBs. I find that the applicant has not provided any medical reports or CNRs to support the reasonableness and necessity of the treatment plan in dispute, other than providing a copy of the treatment plan. I agree with the findings of the Tribunal in Corpuz, where the Tribunal held that an applicant’s evidentiary onus is not discharged by relying on a treatment plan itself. It states that contemporaneous corroborating medical evidence is required to establish entitlement to medical benefits. In addition, I find that while the applicant criticizes the report of Dr. Khan, she has not provided any medical evidence to refute the findings.
49I now turn to the applicant’s arguments with respect to s. 38(8) and s. 38(11) of the Schedule. I find that the EOB was a valid denial. I do not agree that the notice was a boilerplate denial. I find that the EOB identified the treatment plan in dispute and specifies that it is not payable because the applicant’s injuries are minor. The denial further notes that that the respondent has not received compelling evidence to indicate that the applicant’s injuries warrant removal from the MIG and further invites the applicant to provide medical evidence in support that his injuries are not MIG. I further note that as of the date the EOB was provided, the applicant was in non-compliance with the requests for information pursuant to s. 33(1) of the Schedule.
50I find that the respondent provided clear medical and other reasons in its notie, sufficient to allow the applicant to make an informed decision as to whether to accept or dispute the decision. I find this was a clear and unequivocal denial. Although the applicant may disagree with the respondent’s stated reasons, it does not render the notice invalid.
51With respect to the IE that was scheduled in respect to the treatment plan in dispute, it has been established that the applicant was in non-compliance with s. 33(1) of the Schedule as of the date of the May 2, 2023 EOB. Upon receipt of the family physician CNRs in November 2022, the respondent then properly scheduled IE assessments to address the applicant’s entitlement to a NEB and the treatment plan in dispute. The applicant was therefore given proper notice that the treatment plan would be assessed by the IE assessors. I therefore do not agree to exclude Dr. Khan’s report from the evidence considered by the Tribunal.
52For the reasons outlined above, I find on a balance of probabilities, that the applicant has not met her burden of proving that the treatment plan for chiropractic treatment is reasonable or necessary or payable under s. 38(11) of the Schedule.
The applicant is not entitled to the unapproved balance of the treatment plan for psychological services
53The applicant claims entitlement to $523.60 ($3,701.74 less $3,178.14 approved) for psychological services proposed by Somatic Assessments, in a treatment plan dated February 5, 2024.
54The respondent in its EOB, dated February 16, 2024, approved the 14 sessions of psychological treatment as well as the “Planning, service”, “Documentation, support activity” and the “Documentation, support activity for claim form”. It denied the claim for “Brokerage, Service” in the amount of $523.60. The respondent advised,
I am unable to approve line Brokerage, Service” or as we consider the services as administrative cost/cost of doing business. As per FSCO guidelines, “Expenses related to professional services” as referred to in the SABS and the Professional Services Guideline include all administrative costs, overhead, and related costs, fees, expenses, charges and surcharges. Insurers are not liable to for any administrative or other costs, overhead fees, expenses, charges or surcharges that have the result of increasing the effective hourly rates, or the maximum fees payable for completing forms, beyond what is permitted under the Professional Services Guidelines. (sic).
55The applicant submits that brokerage fees are a cost that arises when a treatment provider is responsible for planning treatment for a client, like the organization of meetings and appointments, communicating and coordinating treatment from different providers, and more. The applicant argues that brokerage fees have a code in HCAI, and therefore it is a reasonable cost in connection with the services proposed in the treatment plan in dispute.
56The respondent relies upon the Tribunal decision in Su v. The Dominion of Canada General Insurance Company, 2024 CanLII 123342 (ON LAT), where the Tribunal found that the brokerage fee from the submitting clinic was not payable. The decision states that, “I find that the applicant’s treatment is all provided through one clinic and is uncomplicated. There have been no particulars provided about which team members would need to be consulted with or why this extra consultation would be necessary. I find that a medical file review after each treatment plan to determine whether modification of treatment is necessary is excessive.”
57In my view, the hourly rate for professional services includes things like reviewing external material, scoring and interpretation and brokerage services. Section 15(2)(b) of the Schedule states that the insurer is not liable to pay for medical goods and services that exceed the maximum rate prescribed by the Professional Services Guideline – Superintendent’s Guideline No. 03/14 (“the Guideline”).
58I find that the applicant has not proven on a balance of probabilities that the brokerage fees are reasonable and necessary. I find that the reasonableness of brokerage fees for communication with others depends on factors like the complexity of treatment and the providers involved. I find that the applicant’s psychological treatment is provided through one clinic and one provider and is therefore not complex. There have been no particulars provided about which team members would need to be consulted with or why any extra consultation would be necessary. I find that the applicant has not provided any evidence to support her submission that the applicant’s treatment providers needed to organize meetings and appointments and communicate and coordinate treatment from different providers.
59For the reasons outlined above, I find that the applicant has not proved on a balance of probabilities, that the unapproved balance of the treatment plan for psychological services is reasonable and necessary.
Interest
60Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As there are no benefits owing, the applicant is not entitled to interest.
Award
61The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 percent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits. As I have found that the respondent did not unreasonably withhold or delay payment of any benefit, no award is warranted.
ORDER
62For the reasons outlined above, I find,
i. The applicant is not entitled to a NEB of $185.00 per week from January 5, 2023 to December 8, 2024;
ii. The applicant is not entitled to the treatment plan for chiropractic services or the unapproved balance of the treatment plan for psychological services;
iii. The applicant is not entitled to interest;
iv. The respondent is not required to pay an award, and
v. The application is dismissed.
Released: October 31, 2025
Melanie Malach
Adjudicator