Zaki v. Wawanesa Mutual Insurance Company, 2025 CanLII 125943

Zaki v. Wawanesa Mutual Insurance Company, 2025 CanLII 125943

Citation: Zaki v. Wawanesa Mutual Insurance Company, 2025 ONLAT 24-003830/AABS

Licence Appeal Tribunal File Number: 24-003830/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:

Ebtisam Putros Zaki

Applicant

and

Wawanesa Mutual Insurance Company

Respondent

DECISION

ADJUDICATOR: Melanie Malach

APPEARANCES:

For the Applicant: Daniella Cohen, Paralegal

For the Respondent: Alanna Pink, Counsel

HEARD: By way of written submissions

OVERVIEW

1Ebtisam Putros Zaki, the applicant, was involved in an automobile accident on July 18, 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, Wawanesa Mutual 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 $185.00 per week from August 16, 2022 to March 24, 2023?

ii. Is the applicant entitled to services and assessments proposed by Health-Pro Wellness, as follows:

i. $1,900.00 for an attendant care assessment, in a treatment plan submitted on December 15, 2022;

ii. $4,141.76 for chiropractic services, in a treatment plan submitted on April 25, 2023; and

iii. $4,231.76 for chiropractic services, in a treatment plan submitted on October 6, 2023?

iii. Is the applicant entitled to interest on any overdue payment of benefits?

RESULT

3I find that the applicant is not entitled to a NEB of $185.00 per week from August 16, 2022 to March 24, 2023.

4I find that the applicant is not entitled to the treatment plan proposing an attendant care assessment, submitted December 15, 2022.

5I find that the applicant is entitled to the treatment plans proposing chiropractic services, submitted on April 25, 2023 and October 6, 2023, plus interest.

ANALYSIS

Entitlement to a Non-Earner Benefit (“NEB”)

6I find that the applicant is not entitled to a NEB. 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.

7Section 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 an 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) 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.”

8The 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.

9For 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 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.

10The applicant submits that prior to the accident, she was unemployed and was a full-time homemaker, independently managing all household responsibilities and tasks. She submits that her pre-accident life revolved around household management, and therefore her inability to cook, clean or perform routine chores constitutes a complete inability to carry on a normal life.

11The applicant relies upon the Disability Certificate (“OCF-3”) dated July 21, 2022, which confirms that she was unable to return to normal activities following the accident, supporting her NEB claim. She argues that she meets the criteria in Heath as she has consistently reported how her accident-related injuries hinder her ability to engage in various aspects of her life.

12The applicant relies upon the Tribunal decision in 16-003195 v. State Farm Insurance Company, 2017 CanLII 99136 (ON LAT) (“16-003195”), which applied the test from Galdamez v. Allstate Insurance Company of Canada, 2012 ONCA 508, which interpreted “substantially all” as more than most but not all activities. The applicant submits that given her consistent evidence of her inability to perform a majority of her pre-collision activities, it is clear that the respondent failed to properly acknowledge the accident’s significant impact on her functional capacity.

13The applicant submits that the conclusion made by Dr. Jamie Rusen, orthopedic surgeon, in his Orthopaedic Insurer’s Examination (“IE”) report dated March 21, 2023, that her right shoulder pain is unrelated to the accident, is directly contradicted by the medical evidence. The applicant submits that multiple medical records provide a clear and consistent history of the applicant’s reported right shoulder pain. The applicant further submits that Dr. Rusen’s dismissal of the applicant’s entitlement to a NEB lacks justification because he acknowledged the extent of her pain and functional limitations but then conceded that such conditions fall outside of his expertise. Therefore, his conclusion that the applicant retains the capacity for normal life is both contradictory and unreliable.

14The applicant further submits that the Occupational Therapy Assessment IE report of Sarah Maddix, occupational therapist, dated March 21, 2023, is fundamentally flawed and disregarded the totality of the evidence. Ms. Maddix focused on a handful of isolated abilities and disregarded the broader reality that the applicant is unable to perform the majority of her pre-collision activities. By selectively highlighting minor functional abilities, while ignoring the applicant’s significant losses, Ms. Maddix failed to properly assess the true impact of the collision on the applicant’s functional capacity. Ms. Maddix emphasized the applicant’s ability to perform self-care tasks and ignored her inability to perform household tasks central to her pre-collision life. The applicant declined to demonstrate food preparation, chopping, or cleaning due to her right shoulder and lower back pain.

15The respondent submits that the applicant has not met the test to prove entitlement to a NEB based on the objective IE assessments of Dr. Rosen, orthopedic surgeon, Dr. John Lee, psychologist and Ms. Maddix, occupational therapist. The respondent submits that the applicant has not proven that there is a differentiation between her pre- and post-accident activity which has caused a complete inability to carry on a normal life.

16The respondent submits that the applicant was suffering from pre-existing knee issues. She had had multiple surgeries related to her knees prior to the accident and had been recommended for a knee replacement prior to the accident. In addition, the respondent submits that she suffered from chronic headaches prior to the accident and no evidence has been presented to assess her headaches as different from her pre-existing state. With respect to the applicant’s right shoulder, her pre-accident ultrasound on June 9, 2021, confirmed she had partial tears in her supraspinatus tendon and the subscapularis tendon which are the same tears she had post-accident.

17The respondent submits that while the OCF-3 is dated July 21, 2022, it was not submitted and received until January 17, 2023. The respondent argues that the submission of the OCF-3 was made over 12 weeks beyond the anticipated duration of impairment noted on the OCF-3. No further OCF-3 has been submitted to differentiate or change this finding.

18With respect to the applicant’s reference to the Tribunal decision in 16-003195, the respondent submits that not only is the applicant able to participate in all of her pre-accident activities as referenced in the medical documentation and the IE assessment reports, but she also meets the standard of “substantially all” of her pre-accident activities.

19The respondent relies upon the IE report of Dr. Rosen which concluded that the applicant did not present with any injuries beyond musculoskeletal soft tissue injuries. He found that her alleged limitations were disproportionate with the objective medical findings. The respondent submits that the applicant has not provided any expert reports to respond to Dr. Rosen’s objective findings. The respondent disagrees with the applicant’s argument that Dr. Rosen suggests the presence of chronic pain syndrome but then contradictorily indicates that it is not within his scope to comment on same. It argues that Dr. Rosen merely commented that the applicant has pain focused behaviour that may result from “another etiology” that is outside his scope. From an orthopedic perspective, Dr. Rosen concluded that the applicant does not present with these issues and therefore he cannot comment on why she is exhibiting these behaviours.

20The respondent relies upon the IE report of Ms. Maddix. The respondent submits that the applicant failed to participate in numerous requested tasks based on her subjective belief of inability, and therefore Ms. Maddix relied upon the evidence presented, including the orthopaedic IE assessment of Dr. Rosen and her objective observations to base her conclusions. The respondent submits that declining to participate does not equate to a conclusion of impairment.

21The respondent relies upon the Tribunal decision in Brown v. Economical Mutual Insurance Company, 2024 CanLII 79218 (ON LAT), where the Tribunal held.

the applicant must provide evidence of the frequency and time commitments of the applicant’s pre-accident activities to compare how much less he or she is able to dedicate to the same activity post-accident to discharge his or her burden of proving that she or she is prevented from engaging in “substantially all” of the pre-accident activities in which he or she ordinarily engaged.

22The respondent submits that the applicant has not discharged her onus of proving she is prevented from engaging in “substantially all” of her pre-accident activities. The respondent argues that the applicant has produced minimal medical evidence or documentation showing the differences and changes between the pre- and post-accident activities she alleges she is unable to complete.

23I find that the applicant has not proven on a balance of probabilities that she suffers from a complete inability to carry on a normal life for the following reasons.

24I find that the applicant has not made submissions on the particulars of her pre- and post-accident activities as required in Heath. While she states that she is unable to perform her pre-accident housekeeping duties, without details regarding the activities she valued, or evidence of the frequency and time commitments of her pre-accident activities, I cannot compare her pre- and post-accident ability to engage in activities she ordinarily engaged in or valued and therefore I find that the applicant has not met her onus.

25I find that the only medical evidence that the applicant directed me to in support of her entitlement to a NEB was the OCF-3. I agree with the respondent that while the OCF-3 is dated July 21, 2022, it was not submitted to the respondent until January 17, 2023. The OCF-3 indicated that the disability was for 9-12 weeks, which would have lapsed by the time the OCF-3 was submitted. In addition, the OCF-3 does not particularize the activities that the applicant was unable to perform other than to state, “Ms. Putros reports challenges with ADL’s and recreational tasks requiring bending, lifting from the floor, crouching, kneeling, prolonged positions. Reports sleep disruption”.

26I find under “Injuries and Treatments”, while the applicant referred to the CNR of Dr. Yousra Albir, family physician, dated July 21, 2022, which noted “obvious neck stiffness, a decreased range of motion, and an MSK injury and muscle strain” this record was from two days after the accident. The applicant has not referred to any other CNRs of the family physician in her submissions or pointed me to any CNRs from Health-Pro Wellness, where she attended for physical rehabilitation, to support the limitations she claimed to suffer in her activities of daily living.

27Further, I am persuaded by the evidence of the respondent set out in the March 21, 2023 IE reports of Dr. Rosen, Dr. Lee and Ms. Maddix, which I find provide a thorough analysis and assessment of the applicant’s injuries and directly references the complete inability test. While the applicant criticizes the reports of Dr. Rosen and Ms. Maddix, she has not directed the Tribunal to any medical evidence that contradicts the findings in these reports. I agree with the respondent that Dr. Rosen completed an orthopaedic assessment and found that there was no orthopaedic impairment. I agree with his comment that he is not qualified to assess whether she suffered a chronic pain syndrome. With respect to Dr. Maddix’s report, I further agree with the respondent that declining to participate does not equate to a conclusion of impairment. Dr. Maddix based her conclusions on the applicant’s impairment based on her assessment of the applicant as well as a review of the medical documentation. It is the applicant’s onus to provided medical evidence to support that she suffers the functional limitations and impairments claimed and to demonstrate how they result in a complete inability to carry on a normal life. I do not find that the applicant has pointed me to sufficient medical evidence to support her impairments.

28For the reasons outlined above, I find that the applicant has not proven entitlement to a NEB.

Entitlement pursuant to s. 36(6) of the Schedule

29Section 36(4) of the Schedule sets out the particulars that must be included in the insurer’s denial letters when it decides the applicant does not meet the test for specified benefits. It states that within 10 business days after an insurer receives an application and a completed OCF-3, the insurer shall:

i. pay the specified benefits;

ii. give the applicant notice explaining the medical and other reasons why the insurer does not believe the applicant is entitled to the specified benefit and, if the insurer requires an examination under s. 44 relating to the specified benefit, advising the applicant of the requirement for an examination; or

iii. send a request to the applicant under s. 33(1) of s. 33(2).

30Should the requirements outlined in s. 36(4) of the Schedule not be met, s. 36(6) of the Schedule states:

If the insurer fails to comply with subsection (4) or (5) within the applicable time limit, the insurer shall pay the specified benefit for the period starting on the day the insurer received the application and completed disability certificate, and ending, if the insurer subsequently gives a notice described in subsection (4)(b), on the day the insurer gives the notice.

31The applicant submits that her Application for Accident Benefits (“OCF-1”), dated August 4, 2022, confirms that she was not employed at the time of the accident, making her eligible for a NEB. She submits that the OCF-3, dated July 21, 2022, objectively confirms that she was unable to return to normal activities following the accident, supporting her NEB claim. She argues that the IE reports addressing her entitlement to a NEB were completed between February 16, 2023 and March 7, 2023, yet no proper denial of her NEBs was made until March 24, 2023, which was an unreasonable delay in challenging her entitlement to NEBs. She therefore claims entitlement to retroactive NEB payments pursuant to s. 36(6) of the Schedule.

32The respondent submits that the OCF-3, although dated July 21, 2022, was not submitted and received, until January 17, 2023. The IEs were scheduled and set up by way of correspondence dated January 20, 2023 and February 6, 2023. The IE reports are dated March 21, 2023, and were served on the applicant on March 24, 2023, along with correspondence denying NEBs. The respondent therefore submits that there was no delay in assessing the applicant’s entitlement to a NEB.

33I find that the applicant is not entitled to an NEB pursuant to s. 36(6) of the Schedule. I find that the applicant’s OCF-3 was not submitted to the respondent until January 17, 2023, and IEs were subsequently scheduled for February 16, 2023, February 27, 2023 and March 7, 2023. The IE reports dated March 21, 2023, along with the respondent’s denial, were provided three days later on March 24, 2023. I do not find that there was an unreasonable delay in assessing the applicant’s entitlement to a NEB upon receipt of the OCF-3 on January 17, 2023. I find that the applicant has not provided any evidence to dispute that the submission date of the OCF-3 was not January 17, 2023.

34For the reasons outlined above, I do not find that the applicant has proven entitlement to a NEB pursuant to s. 36(6) of the Schedule.

Entitlement to Medical and Rehabilitation Benefits

35To receive payment for a treatment and assessment plan under sections 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. In the context of an assessment, while the applicant does not need to prove the condition exists, he must prove with persuasive evidence, that there is some accident-related condition that warrants investigation via the proposed assessment.

Entitlement to the treatment plan for an Attendant Care Assessment

36I find that the applicant is not entitled to the treatment plan proposing an attendant care assessment.

37The applicant claims entitlement to $1,900.00 for an attendant care assessment, proposed by Health-Pro Wellness, in a treatment plan submitted on December 15, 2022. The treatment plan recommends a Home Site Assessment. Under Additional Comments, an explanation is provided as to what an attendant care needs assessment is. The goals of the assessment are to determine the “current, future and/or past needs for attendant care required by the patient as a result of the accident” and to “return to activities of normal living.”

38Section 25(1)(4) of the Schedule provides that the insurer shall pay for reasonable fees charged by an occupational therapist or a registered nurse for preparing an assessment of attendant care needs under section 42, including any assessment or examination necessary for that purpose. The applicant bears the onus of establishing that the assessment is reasonable and necessary because of an accident-related impairment.

39The applicant submits that she is entitled to the treatment plan for an attendant care assessment due to her ongoing and debilitating impairments, leaving no doubt as to her entitlement to attendant care benefits. She argues that given her significant limitations in managing household tasks and completing daily activities, an attendant care assessment is both reasonable and necessary. She relies upon the psychological assessment report of Dr. Leon Steiner, psychologist, dated February 5, 2023 and the IE psychological assessment report of Dr. Lee, dated March 21, 2023.

40The respondent submits that the applicant has not provided any evidence as to how the findings of Dr. Steiner and Dr. Lee determine the necessity for an attendant care assessment. The respondent relies upon the IE reports of Dr. Lee, Dr. Rusen and Ms. Mattrix, dated March 21, 2023, which concluded that the applicant did not exhibit any objective physical impairments, and her psychological impairments were noted to not be of a severity to cause her to suffer a complete inability to carry on a normal life.

41The respondent submits that the applicant has not provided any objective evidence showing the necessity for an attendant care assessment. It argues that she has not been diagnosed with any post-accident physical impairments and there is no evidence indicating that her psychological impairments impacted her life to require an assessment of attendant care needs. The respondent notes that there are no restrictions noted in the medical evidence as to what she may or may not do physically and multiple practitioners recommended to her that she be active and resume activities of normal life.

42The respondent further submits that there is no evidence of any incurred treatment for attendant care services, which implies that she has been managing her care for herself since the accident.

43I find that the applicant has not established that the treatment plan for an attendant care assessment is reasonable and necessary for the following reasons.

44I find that the applicant’s submissions focus on her psychological impairments as justification for the need for an attendant care assessment. I find that while Dr. Steiner does diagnose the applicant with a psychological impairment and makes multiple recommendations for psychotherapy treatment and multiple assessments, I note that there is no recommendation for an attendant care assessment based on her psychological diagnosis. I further find that Dr. Steiner does not provide any summary or recommendations with respect to the effect of the applicant’s diagnosis on her functional abilities with respect to performing her housekeeping and personal care activities. I therefore do not find that Dr. Steiner’s report supports the need for an attendant care assessment.

45I further find that the applicant has not provided any submissions as to why she requires an attendant care assessment based on her physical impairments. She has not pointed the Tribunal to any medical evidence from her treating practitioners to support that an attendant care assessment is reasonably required. In my view, it is not the Tribunal’s role to sort through the applicant’s medical evidence, or to search for support for the applicant’s position in the reports provided: see Dooman v. TD Insurance Co. 2025 ONSC 184 at para. 50.

46For the reasons outlined above, I find that the applicant had not proven on a balance of probabilities that the treatment plan for an attendant care assessment is reasonable and necessary.

Entitlement to the treatment plan for chiropractic services

47I find that the applicant is entitled to the treatment plans proposing chiropractic services.

48The applicant claims entitlement to $4,141.76 for chiropractic services, proposed by Health-Pro Wellness, in a treatment plan submitted on April 25, 2023. The plan recommends the following:

18 sessions of manipulations, multiple regions: $900.00
18 sessions of functional exercise: $1,015.38
18 sessions of modalities: $1,015.38
10 sessions of massage therapy: $291.00
Treatment & Assessment Plan: $200.00
Claimant transportation: $720.00

The treatment plan notes that “Patient reports slow improvement with therapy. She is awaiting the date of her surgical procedure of a right-sided rotator cuff repair.”

49The applicant also claims entitlement to $4,231.76 for chiropractic services, proposed by Health-Pro Wellness, in a treatment plan submitted on October 6, 2023. The plan recommends the following:

18 sessions of manipulations, multiple regions: $900.00
18 sessions of functional exercise: $1,015.38
18 sessions of modalities: $1,015.38
10 sessions of massage therapy: $291.00
Treatment & Assessment Plan: $200.00
Claimant transportation: $810.00

50The applicant submits that the goals of the treatment plans in dispute are pain reduction, an increase in range of motion, an increase in strength, and a return to activities of normal living. The applicant submits that these are legitimate, proportional and achievable, given her injuries.

51The applicant relies upon the CNRs of Dr. Albir, Dr. John Townley, orthopedic surgeon, and Dr. David Backstein, orthopedic surgeon, to support that she suffers persistent chronic right shoulder and bilateral knee pain as a result of the accident. She submits that her self-reported symptoms, alongside the clinical findings, underscore the chronic and debilitating nature of her pain.

52With respect to the applicant’s reported right shoulder pain, she submits that the CNR of Dr. Albir, dated August 16, 2022, notes worsening pain in her right shoulder and diagnosed her with rotator cuff tenonitis. An ultrasound of her right shoulder on August 17, 2022, revealed “partial tear of the supraspinatus and subscapularis tendons, with a positive impingement test”. During an appointment with Dr. Townley on September 28, 2022, the applicant’s shoulder pain was confirmed. Despite receiving injections and undergoing shoulder surgery on June 30, 2023, she continued to experience pain. At numerous follow-up appointments with Dr. Townley from November 1, 2022 to March 26, 2024, the applicant persistently complained of pain.

53In regard to the applicant’s persistent knee pain, she submits that her pain ultimately led to a right total knee replacement on November 17, 2023. She continued to report severe and constant pain to her knee to Dr. Backstein and Dr. Albir, from December 4, 2023 to July 3, 2024.

54The respondent submits that the applicant has not presented any objective expert reports in relation to the physical treatment proposed being reasonable and necessary. The respondent argues that the submissions by the applicant are primarily related to her subjective pain complaints or her pre-existing medical issues. In addition, the applicant has not provided sufficient medical evidence or opinion to support that further passive treatment would be reasonable or necessary.

55The respondent submits that the applicant’s pre-existing knee issues, including prior surgeries and recommendations for a knee replacement, pre-dated the accident. The applicant’s complaints post-accident were consistent with her pre-accident medical history in relation to her knee pain and were not accident related.

56The respondent submits that the applicant’s right shoulder tears pre-dated the accident which is evidenced in the pre-accident diagnostic assessment dated June 9, 2021, which revealed tears in both shoulders and arthritis. The respondent argues that the applicant received injections from Dr. Townley post-accident that she reported aided her symptoms significantly. On June 30, 2023, she underwent shoulder surgery and upon discharge was advised by Dr. Townley to “discontinue the use of the sling as soon as the block wore off and could use her arm for light activities”. At her follow up appointment, she continued complaining of pain, but Dr. Townley found her shoulder was moving well with no evidence of frozen shoulder. He noted that she had not discontinued use of the sling despite previous instructions. On August 31, 2023, the applicant was seen by Dr. Townley who indicated there was good range of motion. She had not begun physiotherapy. Her continued complaints were myofascial in nature.

57Before I address the substantive issue in dispute, I will address the issue of causation raised by the respondent. The appropriate test for determining causation in accident benefits causes is the “but for” test, which was confirmed by the Divisional Court in Sabadash v. State Farm et al, 2019 ONSC 1121. To satisfy the test, the applicant must prove on a balance of probabilities that “but for” the accident, she would not have suffered the physical impairments which form the basis of his application for the disputed benefit. The Court in Sabadash sets out that the existence of pre-existing medical conditions does not negate an insurer’s liability, and further, that the accident need not be a necessary cause, and not the only cause, of the impairment.

58The respondent submits that the applicant’s bilateral knee and bilateral shoulder impairments were pre-existing issues and not caused by the accident. The applicant submits that her pre-existing impairments were exacerbated by the accident.

59In comparing the applicant’s pre- and post-accident medical documentation, I find that the medical evidence clearly documents the applicant’s bilateral shoulder and knee complaints. However, in the year leading up to the accident, I do not find that the applicant made any complaints to her family doctor about her knees or shoulders and the medical reports concerning same are from over a year pre-accident. Dr. David Backstein’s orthopedic consultation is dated June 3, 2021 and the bilateral shoulder ultrasound is dated June 9, 2021. I therefore find that while the pre-accident medical documentation confirms that she had impairments prior to the accident, this documentation does not support that she experienced the same level of pain and functional impairment that she suffered post-accident. I find that the applicant’s post-accident complaints are consistently documented by multiple health practitioners following the accident and establish a nexus between the accident and the applicant’s impairments.

60On review of the medical documentation, I find that the preponderance of the evidence supports a finding that the accident is a necessary cause of the increase in severity of the applicant’ s impairments post-accident, and these complaints are reflected in the CNRs of Dr. Albir, Dr. Townley and Dr. Backstein.

61I find that the applicant has proven that the treatment plans in dispute for chiropractic and massage therapy are reasonable and necessary.

62I find that the medical evidence clearly supports the applicant’s ongoing complaints to her bilateral shoulders and bilateral knees post-accident. I find that it was reasonably necessary for the applicant to undergo physical therapy while waiting for her surgeries. I further find that after the applicant underwent her shoulder surgery on June 30, 2023, Dr. Townley continued to assess the applicant on a regular basis and made recommendations for ongoing therapy. In addition, following the applicant’s right knee replacement on November 17, 2023, Dr. Backstein recommended formal rehabilitation for her right knee. I therefore find that the need for the treatment recommended in the treatment plans in dispute is supported by the medical evidence.

63I further find that the goals stated in the treatment plans, including pain reduction, an increase in range of motion, an increase in strength, and a return to activities of normal living, are legitimate goals of treatment to assist the applicant in her preparation for surgery and her recovery thereafter.

64For the reasons outlined above, I find that the applicant has proved on a balance of probabilities that the treatment plans in dispute submitted on April 25, 2023 and October 6, 2023, are reasonable and necessary.

Interest

65Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. As I have found that the applicant is entitled to the treatment plans in dispute submitted April 25, 2023 and October 6, 2023, interest is payable in accordance with s. 51 of the Schedule.

ORDER

66For the reasons outlined above, I find:

i. The applicant is not entitled to a NEB;

ii. The applicant is not entitled to the treatment plan proposing an attendant care assessment, submitted December 15, 2022; and

iii. The applicant is entitled to the treatment plans proposing chiropractic services, submitted on April 25, 2023 and October 6, 2023, plus interest.