Bygrave v. Co-operators General Insurance Company, 2025 CanLII 31135

Bygrave v. Co-operators General Insurance Company

Citation: Bygrave v. Co-operators General Insurance Company, 2025 CanLII 31135

Licence Appeal Tribunal File Number: 22-012555/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:

Althea Bygrave

Applicant

and

Co-operators General Insurance Company

Respondent

DECISION

ADJUDICATOR: Rachel Levitsky

APPEARANCES:

For the Applicant: Gurpreet Farmaha, Counsel

For the Respondent: Daniel Himelfarb, Counsel

HEARD: By way of written submissions

OVERVIEW

1Althea Bygrave, the applicant, was involved in an automobile accident on September 12, 2020, 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, Co-operators General 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 $3,696.50 for physical treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated September 17, 2020?

(ii) Is the applicant entitled to $1,998.80 for an occupational therapy assessment, proposed by Excel Medical Diagnostics in a treatment plan dated October 6, 2020?

(iii) Is the applicant entitled to $248.97 for an invoice prepared by Dr. Dennis Kim for the completion of a disability certificate (OCF-3)?

(iv) Is the applicant entitled to $1,300.00 for chiropractic treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated December 4, 2020?

(v) Is the applicant entitled to $2,200.00 for a psychological assessment, proposed by Excel Medical Diagnostics in a treatment plan dated December 9, 2020?

(vi) Is the applicant entitled to $2,026.55 for chiropractic treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated January 11, 2021?

(vii) Is the applicant entitled to $2,292.43 for occupational therapy and assistive devices, proposed by Excel Medical Diagnostics in a treatment plan dated January 28, 2021?

(viii) Is the applicant entitled to $2,632.85 for a physical assessment, proposed by Excel Medical Diagnostics in a treatment plan dated January 28, 2021?

(ix) Is the applicant entitled to $2,527.80 for a neurological assessment, proposed by Excel Medical Diagnostics in a treatment plan dated March 22, 2021?

(x) Is the applicant entitled to $3,566.29 for psychological therapy, proposed by Excel Medical Diagnostics in a treatment plan dated March 22, 2021?

(xi) Is the applicant entitled to $1,417.70 for assistive devices, proposed by Excel Medical Diagnostics in a treatment plan dated February 2, 2021?

(xii) Is the applicant entitled to $1,300.00 for chiropractic treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated March 1, 2021?

(xiii) Is the applicant entitled to $196.63 for prescription medication, submitted on a claim form (OCF-6) dated July 26, 2021?

(xiv) Is the applicant entitled to $1,417.70 for physical treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated July 23, 2021?

(xv) Is the applicant entitled to $3,566.29 for psychological treatments, proposed by Dr. Aghamohseni in a treatment plan dated July 7, 2021?

(xvi) Is the applicant entitled to $2,635.40 for physical treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated September 3, 2021?

(xvii) Is the applicant entitled to $7,407.03 for occupational therapy, proposed by Excel Medical Diagnostics in a treatment plan dated August 27, 2021?

(xviii) Is the applicant entitled to $3,791.00 for occupational therapy, proposed by Okell of Okell Rehabilitation Services in a treatment plan dated October 20, 2021?

(xix) Is the applicant entitled to $2,200.00 for an occupational therapy assessment, proposed by Okell of Okell Rehabilitation Services in a treatment plan dated October 20, 2021?

(xx) Is the applicant entitled to $3,595.68 for physical treatments, proposed by Natural Touch Rehabilitation Services in a treatment plan dated November 18, 2021?

(xxi) Is the applicant entitled to $2,892.83 for psychological treatments, proposed by Dr. V. Lopo in a treatment plan dated April 26, 2022?

(xxii) Is the applicant entitled to $4,389.03 for psychological treatments, proposed by Dr. N. Sharma in a treatment plan dated April 26, 2022?

(xxiii) Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

(xxiv) Is the applicant entitled to interest on any overdue payment of benefits?

3The applicant withdrew issues 1, 2, 3, and 26-35 as outlined in the Case Conference Report and Order of August 1, 2023 (“CCRO”).

RESULT

4The applicant is entitled to the following treatment plans, plus applicable interest, as they are reasonable and necessary:

(i) $2,200.00 for a psychological assessment, proposed by Excel Medical Diagnostics in a treatment plan dated December 9, 2020 (issue (v));

(ii) $3,566.29 for psychological therapy, proposed by Excel Medical Diagnostics in a treatment plan dated March 22, 2021 (issue (x));

(iii) $3,566.29 for psychological treatments, proposed by Dr. Aghamohseni in a treatment plan dated July 7, 2021 (issue (xv));

(iv) $7,407.03 for occupational therapy, proposed by Excel Medical Diagnostics in a treatment plan dated August 27, 2021 (issue (xvii)); and

(v) $2,818.14 out of the $4,389.03 proposed by Dr. Sharma for psychological treatments in a treatment plan dated April 26, 2022 (issue (xxii)).

5The applicant is entitled to payment for the following treatment plans, plus applicable interest, by operation of s. 38(11), once incurred and properly invoiced:

(i) $3,696.50 for physical treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated September 17, 2020 (issue (i));

(ii) $1,998.80 for an occupational therapy assessment, proposed by Excel Medical Diagnostics in a treatment plan dated October 6, 2020 (issue (ii));

(iii) $1,300.00 for chiropractic treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated December 4, 2020 (issue (iv));

(iv) $2,026.55 for chiropractic treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated January 11, 2021 (issue (vi));

(v) $2,292.43 for occupational therapy and assistive devices, proposed by Excel Medical Diagnostics in a treatment plan dated January 28, 2021 (issue (vii));

(vi) $2,632.85 for a physical assessment, proposed by Excel Medical Diagnostics in a treatment plan dated January 28, 2021 (issue (viii)); and

(vii) $1,417.70 for assistive devices, proposed by Excel Medical Diagnostics in a treatment plan dated February 2, 2021 (issue (xi)).

6The applicant is entitled to the cost of the items in dispute in the OCF-6 dated July 26, 2021 (issue (xiii)), plus interest.

7The applicant is not entitled to the remainder of the treatment plans in dispute or the cost of the OCF-3.

8The respondent is not liable to pay an award.

PROCEDURAL ISSUE

9Pursuant to the CCRO, the applicant’s submissions were due thirty days prior to the hearing, which was April 3, 2024. The applicant served her submissions on April 5, 2024. The respondent objected to the applicant’s submissions being accepted by the Tribunal as they were two days late. The applicant then brought a motion requesting that her submissions not be struck from this hearing.

10The respondent submits that the applicant has failed to provide an explanation for the delay in her submissions, and her motion should be dismissed. It argues that granting the applicant additional time to file submissions is prejudicial, as it was entitled to consider the imposed timelines as final and anticipate a decision of the issue without unwarranted delays.

11The respondent did not argue that it was unable to respond to the applicant’s submissions by the deadline specified in the CCRO, or that any action required of it was impacted by the delay. Further, the hearing itself was not delayed by the late submissions. I am accordingly not convinced that the respondent was actually prejudiced by the two-day delay. Even if there has been some theoretical prejudice to the respondent, there would be significant prejudice to the applicant if she was unable to make submissions regarding her entitlement to the issues in dispute. While I agree that the timelines imposed by the CCRO should be upheld, the CCRO also indicates that the orders made are subject to the hearing adjudicator’s discretion. I find that it would be preferable to deal with the case on its merits rather than refuse to allow the applicant to make submissions, and I will accordingly consider her submissions in this hearing.

ANALYSIS

12To 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.

13Under s. 38(8), an insurer has the obligation to, within 10 business days after it receives a treatment plan, provide an insured person with a notice identifying the medical and all of the other reasons why the insurer finds the treatment plan not to be reasonable and necessary.

14If the insurer fails to give a notice in accordance with s. 38(8) in connection with a treatment plan, the following rules found in s. 38(11) apply: (a) the insurer is prohibited from taking the position that the insured person has an impairment to which the Minor Injury Guideline (“MIG”) applies, and (b) the insurer shall pay for all goods, services, assessments and examinations described in the treatment and assessment plan that relate to the period starting on the 11th business day after the day the insurer received the application and ending on the day the insurer gives a notice described in subsection (8).

15In addition to arguing that the treatment plans in dispute are reasonable and necessary, the applicant submits that they are payable by virtue of s. 38(11) of the Schedule. The respondent disagrees.

$3,696.50 for physical treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated September 17, 2020 (issue (i))

$1,300.00 for chiropractic treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated December 4, 2020 (issue (iv))

16I find that these treatment plans are payable once incurred and properly invoiced by the applicant.

17The treatment plan identified as issue (i) was denied on September 22, 2020, as the respondent determined that the applicant’s injuries fell within the definition of the MIG. The treatment plan identified as issue (iv) was partially approved for $1,100.00 on December 16, 2020, and the remaining $200.00 proposed in the treatment plan was also denied because of the MIG. However, according to an account summary from the treatment provider, the respondent only paid $1,084.52 for this treatment plan and the outstanding amount is $215.48. The denial letters do not state that the treatment plans were being denied because they were not reasonable and necessary; they were only denied because of the application of the MIG. On April 19, 2023, the applicant was removed from the MIG as a result of opinions from s. 44 assessors.

18The applicant submits that once she was removed from the MIG, the respondent had an obligation to re-evaluate the treatment plans initially denied on the basis of the MIG, and this obligation involved providing medical and other reasons for the denial as per s. 38(8) of the Schedule.

19The applicant relies on Yang v. Dominion of Canada General Insurance Company (Travelers), 2022 CanLII 23412, where treatment plans were initially denied solely due to there being no funding left under the MIG. Once the insured was taken out of the MIG, and the reason for the denial was no longer true, the respondent had an obligation to re-evaluate the reasonableness and necessity of the treatment plans. As the insurer failed to provide medical and other reasons for the denial, it was found liable to pay for the services outlined in the treatment plans pursuant to s. 38(11)2. Although not binding on me, I am persuaded by the reasoning in Yang.

20The respondent has not directed me to any evidence that it provided a new denial notice for these treatment plans once the applicant was removed from the MIG. I accordingly find that the respondent has failed to provide the applicant with medical reasons for the denial of these treatment plans in accordance with s. 38(8).

21The respondent submits that in accordance with the Divisional Court decision of Aviva General Insurance Company v. Catic, 2022 ONSC 6000 (“Catic”), only services that have been incurred are payable. However, although neither party directed me to the Divisional Court decision of Aviva Insurance Company of Canada v. Danay Suarez, 2021 ONSC 6200 (“Suarez”), I am also bound by it.

22In Suarez, the Divisional Court ruled that where an insurer fails to provide a proper s. 38(8) notice and does not cure the deficiency before the Tribunal has adjudicated the dispute in favour of the insured, then the insured can proceed to consume the disputed treatment plan. The insurer cannot subsequently cure their defective denial.

23This can be distinguished from Catic, where the Court held that treatment must be incurred to be payable in cases where a deficient notice is subsequently corrected by a proper notice. In the matter at hand, as the insurer did not lead evidence to establish that the deficient notices were cured, I find that the reasoning in Suarez is applicable.

24I accordingly find that the unpaid amounts relating to these treatment plans are payable once incurred and properly invoiced by the applicant.

$2,026.55 for chiropractic treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated January 11, 2021 (issue (vi))

25I find that this treatment plan is payable once incurred and properly invoiced by the applicant.

26Similar to the treatment plans above, this treatment plan was denied on the basis of the application of the MIG. The denial letter, dated January 19, 2021, advised the applicant that a s. 44 assessment would be arranged. The respondent has not directed me to any subsequent denial letter for this specific treatment plan stemming from the s. 44 assessment. Further, it has not directed me to a subsequent denial letter for this treatment plan after the applicant was removed from the MIG. For the same reasons as above, I agree with the applicant that the respondent did not comply with s. 38(8) for this treatment plan and thus it is payable pursuant to s. 38(11).

$2,632.85 for a physical assessment, proposed by Excel Medical Diagnostics in a treatment plan dated January 28, 2021 (issue (viii))

27I find that this treatment plan is payable once incurred and properly invoiced by the applicant.

28This treatment plan was denied on February 10, 2021. I have reviewed the denial letter and while it does state that the treatment plan is not reasonable and necessary, the only reason provided appears to be the application of the MIG. The respondent submits that this treatment plan was reconsidered following s. 44 assessments, but has not directed me to evidence of a subsequent letter denying the expense. For the same reason as above, I find that the respondent had an obligation to readjust this treatment plan after the applicant was removed from the MIG, and as there is no evidence that it did so, the treatment plan is payable pursuant to s. 38(11).

29However, the respondent also submits that the cost of the assessment exceeds the maximum amount of $2,000.00 plus H.S.T. set out in s. 25(5)(a) of the Schedule. The treatment plan proposes $2,000.00 for a physiatry assessment, $200.00 for the completion of the treatment plan, $145.00 for transportation for the applicant, and $278.85 in H.S.T.

30Section 25(5)(a) states that an insurer shall not pay more than $2,000.00 plus H.S.T. in respect of fees and expenses for conducting any one assessment or examination and for preparing reports in connection with it. Section 25(1)3 states that the insurer shall pay reasonable fees charged for reviewing an approving a treatment plan if the cost of the assessment is payable. The Financial Services Commission of Ontario’s Superintendent’s Guideline No. 03/14 states that the $200.00 maximum fee for preparing the treatment plan does not apply to the assessments proposed in that treatment plan, and the Tribunal has consistently held that $200.00 for the completion of the treatment plan is not included within the $2,000.00 maximum set out in s. 25(5)(a). Further, s. 25(4) states that an insurer shall pay reasonable authorized transportation expenses incurred to transport an insured person to and from an assessment. Like s. 25(1)3, this shall-pay provision is separate from s. 25(5)(a), and in my view should be treated similarly to the expense for the preparation of the treatment plan. Transportation expenses reimburse an insured for attending an assessment, and do not pay for an assessor’s costs to conduct an assessment or write reports. I accordingly find that transportation expenses for an insured are payable separate and apart from the $2,000.00 maximum payable for the assessment. I note that as the treatment plan is payable pursuant to s. 38(11), the applicant need not prove that the components of the treatment plan are reasonable and necessary. I find that since the treatment plan complies with s. 25(5)(a), it is payable in its entirety.

$1,417.70 for assistive devices, proposed by Excel Medical Diagnostics in a treatment plan dated February 2, 2021 (issue (xi))

31I find that this treatment plan is payable once incurred and properly invoiced by the applicant.

32I note that there is no treatment plan for $1,417.70 proposed by Excel Medical Diagnostics for assistive devices dated February 2, 2021, before me. There is a treatment plan for $1,417.70 dated February 26, 2021, which proposes various treatment modalities, an assessment, and gloves. This may have been due to a typographical error in the CCRO, however the applicant referred to the issue as it was listed in the CCRO and has not directed me to a tab in her document brief with a copy of the treatment plan in dispute. In its submissions, the respondent referred me to the $1,417.70 treatment plan dated February 26, 2021. The applicant did not take issue with this in her reply submissions. As I have not been provided with any further guidance, I will assume that the treatment plan in dispute is the one dated February 26, 2021.

33This treatment plan was denied by way of letter dated March 5, 2021, because the applicant was in the MIG, and a s. 44 assessment was requested. The applicant submits that this denial was never re-adjusted following her removal from the MIG. The respondent submits that the denial was upheld in a letter dated April 19, 2023, after the applicant underwent s. 44 assessments.

34The letter of April 19, 2023, advised the applicant that she was removed from the MIG, and quoted from the reports of Dr. Gilbert Yee, orthopaedic surgeon, and Dr. Liaqat Ali, psychiatrist. The letter also mentions the treatment plan, and subsequently quotes the following from Dr. Yee’s report: “From an orthopaedic perspective, there is a possibility of sacral deformity as a posttraumatic injury which would place her outside the Minor Injury Guidelines. A CT scan of the sacrum would be appropriate for further evaluation to assess any bony pathology and I defer comment until I have had the opportunity to review this.” Despite the respondent’s assertion that the denial was upheld, the letter does not state whether the treatment plan remained denied or whether it was approved.

35The respondent submits that the applicant has yet to provide the respondent with a CT scan report and there is no evidence that this scan has been requested from any treating practitioner. However, the letter of April 19, 2023, does not specify that the applicant is required to attend a CT scan. It simply quotes from Dr. Yee without providing any clear information about what it requires the applicant to do. In any event, I find that the respondent’s alleged request for a CT scan does not supplant its obligation under s. 38(8) to advise the applicant if it agrees or does not agree to pay for the treatment plan.

36I agree with the applicant that this notice did not comply with s. 38(8) because there is no indication in this letter as to whether the treatment plan was approved or denied. The respondent has not directed me to any subsequent correspondence indicating that this was ever done. I accordingly find that the treatment plan is payable pursuant to s. 38(11) once incurred and properly invoiced by the applicant.

$1,417.70 for physical treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated July 23, 2021 (issue (xiv))

$2,635.40 for physical treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated September 3, 2021 (issue (xvi))

$3,595.68 for physical treatments, proposed by Natural Touch Rehabilitation Services in a treatment plan dated November 18, 2021 (issue (xx))

37I find that the applicant is not entitled to these treatment plans, and they are not payable pursuant to s. 38(11).

38The applicant acknowledges that these treatment plans were denied on the basis of the MIG, but also because of the findings of s. 44 physiatrist Dr. Raymond Zabieliauskas. She does not argue that the initial denial letters were not compliant with s. 38(8). I have reviewed them and find that the letters provided clear denials with medical reasons in accordance with s. 38(8), specifically the application of the MIG and Dr. Zabieliauskas’ opinion that further formal rehabilitation or treatment was not reasonable and necessary. While I agree with the applicant that the subsequent letter of April 19, 2023, which also mentioned these treatment plans, did not comply with s. 38(8), I find that the treatment plans were already properly denied in accordance with s. 38(8) and the April 19, 2023, letter did not change that fact. I accordingly find that these treatment plans are not payable as a result of s. 38(11).

39Although the applicant submits generally that all of the treatment plans in dispute are reasonable and necessary, she does not make specific submissions about these ones in particular. Despite receiving physical treatment in the months prior to the submission of these treatment plans, the applicant has not directed me to compelling evidence showing that this type of treatment was helpful, or to what degree, in order to prove that the cost of achieving the treatment goals is reasonable.

40The respondent submits that the applicant has, on multiple occasions, mentioned that physical treatment was not helpful. On January 28, 2021, the applicant visited Dr. Sara Behrouz at the Centres for Pain Management, and advised that chiropractic care and physiotherapy was not helpful. On December 19, 2022, the applicant attended the Wasser Pain Management Centre and advised Dr. Rahul Pathak that she tried physiotherapy in the past, but it made her feel worse. The applicant also advised Dr. Zabieliauskas on April 12, 2021, that she reported no particular relief of her pains when receiving therapy. Although the applicant provided a detailed letter to the respondent indicating that there were errors in Dr. Zabieliauskas’ report, she did not advise that his note regarding her response to treatment was an error.

41I am accordingly not persuaded on a balance of probabilities that, around the time the treatment plans were submitted, further physical treatment was reasonable and necessary. As such, I find that the applicant is not entitled to these treatment plans.

$1,300.00 for chiropractic treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated March 1, 2021 (issue (xii))

42I find that the applicant is not entitled to this treatment plan.

43The applicant did not make any submissions with respect to this treatment plan and has not provided me with a copy of it. Without any explanation as to why she is entitled to it or what services the treatment plan proposed, I find that she has not met her onus to prove on a balance of probabilities that this treatment plan is reasonable and necessary. Further, the applicant did not make any argument that the respondent breached s. 38(8) with respect to this treatment plan. Without knowing whether the applicant takes issue with the denial letter pertaining to this specific treatment plan, I will not engage in an analysis in that regard.

$2,200.00 for a psychological assessment, proposed by Excel Medical Diagnostics in a treatment plan dated December 9, 2020 (issue (v))

44I find that the applicant is entitled to this treatment plan.

45In my view, there is compelling evidence from around the time the treatment plan was submitted that the applicant was experiencing psychological symptoms that warranted further investigation by way of an assessment. The records from the applicant’s family physician, Dr. Kim, from September 2020 indicate that she was experiencing depression and nightmares. The treatment plan included a pre-screen report by Fahimeh Aghamohseni, psychologist, which indicated that the applicant had been experiencing severe symptoms of depression and anxiety since the accident. Further, Sonia Sharma, occupational therapist, also recommended in a report dated November 30, 2020, that the applicant undergo a psychological assessment to address the emotional sequalae of her symptoms.

46Despite the respondent’s denial of this treatment plan, the applicant underwent an assessment with Ms. Aghamohseni on January 14, 2021. The applicant reported that she cried all the time, and had feelings of loneliness due to social isolation, feelings of worthlessness, and loss of interest in activities and people. Ms. Aghamohseni noted that she experienced symptoms consistent with a heightened state of anxiety, and was angry, irritable, and impatient most of the time. Although she had returned to driving, she was reluctant to be in a vehicle as she had elevated feelings of fear and nervousness. She reported dreaming of the accident often. Her scores on psychometric testing indicated a severe level of depression, and a moderate level of anxiety. Ms. Aghamohseni diagnosed the applicant with Major Depressive Disorder, Somatic Symptom Disorder, and Specific Phobia, situational type, vehicular. She indicated that although prior to the accident the applicant was experiencing symptoms of depression and anxiety, her symptomatology worsened following the accident.

47The applicant also underwent a s. 44 assessment with Dr. Janet Patterson, psychiatrist, on April 27, 2021. She reported to Dr. Patterson that although she was suffering from depression prior to the accident, her depression worsened afterwards. She also reported that she was experiencing nightmares where a car is coming towards her, feeling anxious while driving, and that her heart races. Dr. Patterson indicated that “it is difficult to assess to what extent her condition may have been worsened by the MVA due to the possibility that she is exaggerating her symptoms”. She diagnosed the applicant with Major Depressive Disorder and Conversion Disorder, but opined that her mental health issues pre-dated the accident and that she did not require an additional psychological assessment.

48I note that after undergoing a subsequent s. 44 assessment with Dr. Liaqat Ali, psychiatrist, on December 2, 2022, the applicant was diagnosed with Major Depressive Disorder, Somatic Symptom Disorder, and Post-Traumatic Stress Disorder. Dr. Ali opined that the applicant’s pre-accident symptoms would not have been exacerbated to their current level but for the accident. I find that this corroborates Ms. Aghamohseni’s diagnoses and opinions. Considering Dr. Ali and Ms. Aghamohseni did not have difficulty opining that the applicant’s condition was worsened by the accident, I question why Dr. Patterson did. I do not agree with the respondent’s assertion that Ms. Aghamohseni did not consider the applicant’s pre-accident history; in her report, she addresses the applicant’s childhood trauma and pre-accident depression and anxiety which was exacerbated in June 2020. Additionally, Dr. Patterson did not conduct any psychological testing outside of her clinical interview, whereas Ms. Aghamohseni administered a battery of five tests in addition to her clinical interview. For those reasons, I find Ms. Aghamohseni’s opinion to be more persuasive than Dr. Patterson’s.

49The goals of the treatment plan were to determine the applicant’s psychological status, provide recommendations for psychological support, and restore her pre-accident level of psychological functioning. I find that it was reasonable and necessary at the time, given the applicant’s complaints to Dr. Kim, Ms. Sharma, and Ms. Aghamohseni during the pre-screen, and her reported symptoms to Dr. Patterson, for the applicant to explore the possibility that she suffered from an accident-related psychological impairment and determine whether treatment was warranted.

50The fact that the applicant underwent a subsequent psychological assessment with Dr. Sharma on June 12, 2022, approximately 1.5 years later, does not impact my finding that the disputed assessment was reasonable and necessary at the time the treatment plan was submitted. My decision is based on the applicant’s reported complaints and condition at that time, and in my view the assessments were not so close together that they were duplicative.

51I accordingly find that the applicant has proven, on a balance of probabilities, that she is entitled to this treatment plan.

$3,566.29 for psychological therapy, proposed by Excel Medical Diagnostics in a treatment plan dated March 22, 2021 (issue (x))

$3,566.29 for psychological treatments, proposed by Dr. Aghamohseni in a treatment plan dated July 7, 2021 (issue (xv))

52I find that the applicant is entitled to these treatment plans.

53The treatment plans each propose 12 one-hour sessions of psychological therapy, 12 half-hour blocks of time for pre- and post-session preparation and notes, 4.5 hours for a progress re-evaluation and report, and the cost of completing the treatment plan.

54Dr. Patterson opined that the applicant was not a candidate for psychotherapy due to her demeanor during the assessment. However, the applicant began psychotherapy with Ms. Aghamohseni on April 14, 2021, and Dr. Ali subsequently recommended additional psychotherapy and did not suggest that she was not a candidate for it. I do not accept Dr. Patterson’s opinion in that regard, and as indicated above, I prefer the conclusions made by Ms. Aghamohseni. I accept that, given the applicant’s reported difficulties, the twelve psychological treatment sessions proposed by Ms. Aghamohseni in her report and in the treatment plan were warranted, and it was reasonable and necessary at the time it was submitted.

55The second treatment plan, prepared by Ms. Aghamohseni, indicated that the applicant had improved slightly as a result of psychotherapeutic intervention, but was still struggling. Ms. Aghamohseni noted that the applicant was living in a heightened state of anxiety regarding her future, an inability to come to terms with her injuries, frustration with her vocational circumstances, difficulties with interpersonal relationships and ability to care for her daughter, and her in-vehicle difficulties. Considering the severity of the applicant’s difficulties which were superimposed onto her pre-accident psychological condition, and the fact that she saw some improvement after the first twelve sessions of treatment, I find that it was reasonable and necessary for the applicant to have undergone a second round of psychological treatment.

56The respondent argues that, based on the opinion of Dr. Ali, psychological treatment was approved in 2023, and there has been no compelling evidence of a need for additional counselling beyond what was approved. I do not accept this argument in regard to these treatment plans, as Dr. Ali recognized in her report that the applicant had already received psychological counselling, and still recommended more counselling in addition to what she had received.

57The applicant attended hour-long treatment sessions with Ms. Aghamohseni and Marlen Iskander, registered psychotherapist. I find that it was appropriate for the treatment providers to also allot time for preparation and notes. Further, I accept that a re-assessment by the same treatment provider was warranted to determine whether the therapy was helpful and whether further intervention was required. I also note that the respondent does not take issue with any of the particular line items in these treatment plans. I accordingly find that the applicant is entitled to the entirety of the treatment plans.

58I find that the applicant has met her burden to prove, on a balance of probabilities, that these treatment plans were reasonable and necessary around the time they were submitted, and she is accordingly entitled to them.

$4,389.03 for psychological treatments, proposed by Dr. N. Sharma in a treatment plan dated April 26, 2022 (issue (xxii))

59I find that the applicant is entitled to $2,818.14 out of the $4,389.03 proposed in this treatment plan.

60The treatment plan proposes 18 sessions of psychotherapy at $187.01 for each 1.25 hour session, which includes a pre-session file review and session documentation. It also proposes 2 hours of service planning and document review, 2.5 hours for a progress review and report, 1 hour of telephone communication, and $200.00 for the completion of the treatment plan. I also note that despite the wording of this issue in the CCRO, the date of the treatment plan is June 13, 2022.

61The respondent partially approved this treatment plan in the amount of $2,144.93 on April 19, 2023, based on the opinion of Dr. Ali that twelve sessions of psychotherapy was reasonable and necessary at a rate of $149.61 per hour. One hour of documentation support at $149.61 and the completion of the treatment plan at $200.00 was also approved. The amount in dispute is accordingly $2,244.10.

62I accept that an initial treatment plan of 12 sessions was appropriate based on Dr. Ali’s opinion and similar treatment plans prepared by Ms. Aghamohseni. The need for further treatment could be assessed after the sessions had concluded, and I therefore find that the proposed progress review and report was also reasonable and necessary. I also accept Dr. Sharma’s proposal for 1.25 hours per treatment session, as that included time for pre-session file review and note taking, which I find is a reasonable and necessary component of the sessions. However, I have not been provided with a compelling explanation as to why an additional two hours were warranted for service planning and document review, and an explanation has not been provided as to how a document review is different from a file review. Further, the applicant has not directed me to a compelling explanation as to why 1 hour of telephone communication was necessary, so I find that she is not entitled to that amount.

63I note that the applicant does not argue that this treatment plan is payable pursuant to s. 38(11) and I accordingly will not engage in an analysis in that regard.

64In total, I find that the applicant has proven, on a balance of probabilities, that she is entitled to $2,818.14 out of the $4,389.03 proposed in this treatment plan.

$2,892.83 for psychological treatments, proposed by Dr. V. Lopo in a treatment plan dated April 26, 2022 (issue (xxi))

65I find that the applicant is not entitled to this treatment plan.

66The treatment plan proposes 12 sessions of psychotherapy, a progress report, a re-assessment, and the cost of completing the treatment plan. It was denied because Dr. Ali opined that it was a duplication of services, as Dr. Sharma’s treatment plan above was already partially approved. The applicant argues generally that the treatment plan is warranted based on the severity of her psychological impairments and the need for ongoing treatment. I note that she does not make any submissions regarding s. 38(8) with respect to this treatment plan so I will not engage in that analysis.

67The applicant has not directed me to compelling evidence that the treatment goals were being met such that another round of similar treatment was warranted around the time the treatment plan was submitted. She has not directed me to a compelling opinion contrary to that of Dr. Ali’s which would explain why additional treatment was appropriate. Further, she has not explained why two treatment plans for the same services from different providers would have been reasonable and necessary around the same time. I accordingly find that she has not met her burden of proving, on a balance of probabilities, that this treatment plan was reasonable and necessary around the time that it was submitted, and she is not entitled to it.

$2,527.80 for a neurological assessment, proposed by Excel Medical Diagnostics in a treatment plan dated March 22, 2021 (issue (ix))

68I find that the applicant is not entitled to this treatment plan.

69The treatment plan proposed an assessment with Dr. Vincenzo Basile, neurologist. Despite the denial, the applicant underwent the assessment with Dr. Basile on May 27, 2021. He diagnosed her with postconcussive syndrome consistent with a traumatic brain injury, posttraumatic headaches, an indication of cervical and lumbosacral radiculopathy, and vertigo. The applicant submits that the assessment was reasonable and necessary given Dr. Basile’s diagnoses.

70I agree with the respondent that there is no compelling evidence of neurological issues outside the report of Dr. Basile, particularly around the time this treatment plan was submitted. The applicant visited Dr. Lesley Corrin, neurologist, on December 8, 2020, who conducted EMG testing and indicated that there was no evidence of cervical or lumbosacral radiculopathy. She also visited Dr. Mark Bryer, neurologist, on December 19, 2020. Dr. Bryer indicated that she had a normal neurological examination, and that there was no electrodiagnostic support for peripheral nerve pathology including radiculopathy or entrapment neuropathy. Dr. Bryer opined that the applicant’s headaches sound like chronic migraine associated with excessive analgesic consumption. He recommended a trial of medication for this.

71The applicant has not directed me to compelling evidence that would corroborate Dr. Basile’s conclusions. I have reviewed the list of documents that were provided to Dr. Basile, and it does not appear that he reviewed the notes from Dr. Bryer or Dr. Corrin in coming to his conclusion. I am accordingly not persuaded by his diagnoses.

72Further, I find that the applicant has failed to explain why an additional neurological assessment was required shortly after she was already assessed by two other neurologists.

73The applicant submits that as the respondent believed that it was reasonable and necessary to send the applicant for a s. 44 neurological assessment, it stands to reason that the treatment plan for a neurological assessment is equally reasonable and necessary. However, the only s. 44 neurological assessment before me was conducted in December 2024 as part of catastrophic impairment evaluations. In my view, just because the respondent obtained a neurological opinion over 3.5 years after the treatment plan was submitted does not necessarily mean that a neurological assessment was reasonable and necessary at the time. I am accordingly not compelled by this argument.

74The applicant also argues that the treatment plan is payable as the respondent breached s. 38(8) by failing to reassess the treatment plan after she was removed from the MIG. I have reviewed the initial denial letter, dated April 1, 2021, and it appears that the treatment plan was not denied solely because the applicant was in the MIG. The respondent also denied the treatment plan because it believed it was not required pursuant to s. 47(2) of the Schedule to fund an expense that is reasonably available under any insurance plan or law, and that this assessment is covered through OHIP. I need not determine whether the respondent was correct in its reason for the denial, however I find that the respondent complied with s. 38(8) in its letter of April 1, 2021. The reason for the denial still stood despite the applicant’s removal from the MIG, and thus it was not required to provide a subsequent notice letter for this treatment plan.

75I accordingly find that the applicant has not proven, on a balance of probabilities, that this treatment plan is reasonable and necessary, or that it is payable by operation of s. 38(11).

$1,998.80 for an occupational therapy assessment, proposed by Excel Medical Diagnostics in a treatment plan dated October 6, 2020 (issue (ii))

$2,292.43 for occupational therapy and assistive devices, proposed by Excel Medical Diagnostics in a treatment plan dated January 28, 2021 (issue (vii))

76I find that the treatment plans are payable pursuant to s. 38(11) once incurred and properly invoiced by the applicant.

77The applicant submits that these treatment plans are payable pursuant to s. 38(11) because they were denied solely on the basis of the MIG, and were not readjusted subsequent to her removal from the MIG. The respondent did not make any submissions as to the sufficiency of notice with respect to these treatment plans.

78I have reviewed the denial letters for the items in dispute. The treatment plans at issues (ii) and (vii) were denied because of the MIG, and not because the respondent deemed them not to be reasonable or necessary. The respondent has not directed me to any evidence that these treatment plans were re-adjusted after the applicant was removed from the MIG. I accordingly find that the respondent did not comply with s. 38(8) with respect to these treatment plans and therefore they are payable pursuant to s. 38(11) once incurred and properly invoiced by the applicant.

$7,407.03 for occupational therapy, proposed by Excel Medical Diagnostics in a treatment plan dated August 27, 2021 (issue (xvii))

$3,791.00 for occupational therapy, proposed by Okell of Okell Rehabilitation Services in a treatment plan dated October 20, 2021 (issue (xviii))

$2,200.00 for an occupational therapy assessment, proposed by Okell of Okell Rehabilitation Services in a treatment plan dated October 20, 2021 (issue (xix))

79I find that the applicant is entitled to the treatment plan identified as issue (xvii). She is not entitled to the treatment plans identified as issues (xviii) or (xix).

80The applicant submits that these treatment plans are payable pursuant to s. 38(11) because they were denied solely on the basis of the MIG, and were not readjusted subsequent to her removal from the MIG.

81With respect to issue (xvii), although the letter of October 18, 2021, initially refers to the MIG as the reason for the denial, under the subheading “medical and all other reasons for denied expenses”, it also refers to Dr. Zabieliauskas’ opinion that no further formal rehabilitation or treatment would be required. Similarly, issues (xviii) and (xix) were denied on November 4, 2021, as a result of the MIG, but also as a result of Dr. Zabieliauskas’ opinion. As the MIG was not the only stated reason for the denials, I find that there was no need to readjust these treatment plans after the applicant’s removal from the MIG in order to be compliant with s. 38(8). These treatment plans are accordingly not payable as a result of s. 38(11).

82The treatment plan identified as issue (xvii) proposed four 1.5 hour sessions of occupational therapy, a progress report, review of external file materials, travel time, communication and supervision with a rehabilitation support worker (“RSW”) and the applicant, 16 three-hour sessions of RSW service, RSW travel time, a RSW progress report, disbursement fees (to be billed if used), communication with service providers, review of medical documents and treatment planning, and preparation of the treatment plan. The treatment plan at issue (xviii) proposed ten 1.5 hour sessions of occupational therapy plus 30 minutes of planning and preparation for each session and communication with treatment providers, preparation of update notes and a progress report, completion of the treatment plan, and travel time for the therapist. The treatment plan identified as issue (xix) proposed an occupational therapy assessment.

83Occupational therapy and rehabilitation support worker services were recommended by Ms. Sharma in her report of November 30, 2020. Ms. Sharma indicated in her report that the applicant required education with respect to relaxation modalities, pacing techniques due to deconditioning and decreased energy levels, pain management strategies including a pain log, strategies to progress mobility with a focus on safety, regain independence in her activities of daily living including dressing, cooking, and cleaning, use assistive devices properly, and improve cognitive deficits. An RSW was recommended to help increase her engagement in meaningful activities.

84Shortly after the treatment plan was submitted, Ms. Sharma’s recommendations were echoed in the occupational therapy report of Adrienne Baker from November 24, 2021. Ms. Baker recommended occupational therapy in order to, amongst other things, help establish her routine, provide education on compensatory strategies to assist with memory and attention issues, provide education on ergonomic postures, energy conservation and pacing, sleep hygiene, and task modification, and explore ways to allow for meaningful social/recreational engagement. She also recommended RSW support for community reintegration, improving her health and well-being, decreasing social isolation, and assisting with a prescribed exercise program.

85I do not accept the respondent’s submission that because the applicant received assistance from a personal support worker and psychological counselling, the proposed treatment plan is excessive given the extent of support she has received. Occupational therapy and RSW services are not the same as psychological counselling and personal support worker services. The respondent has not made a compelling argument as to how these services would overlap such that they would be duplicative.

86Further, I am not persuaded by the respondent’s argument that the treatment plan is not reasonable and necessary because the applicant drives regularly, gambles and plays bingo, and volunteers with her daughter’s soccer team. Bridget Marshall, occupational therapist, indicated in a letter dated June 6, 2023, that the applicant had issues with gambling after the accident in order to cope with thoughts of self-harm. The respondent refers to a note from August 3, 2023, from a treatment session with Dr. Sharma, that states that the applicant was pushing herself to volunteer as the coach of her daughter’s team. However, the next sentence states that the applicant waits for it to be over as it is too much for her, so it does not appear that the applicant is truly able to engage in this activity. In any event, just because the applicant is involved in some activities does not necessarily mean she is not a candidate for occupational therapy.

87Given the recommendations from both occupational therapists, I find that it was reasonable for her to have received occupational therapy and rehabilitation support worker services around the time the treatment plan was submitted. Although she does not specify in her report how many treatment sessions would be required, Ms. Sharma submitted the treatment plan at issue (xvii) and made reference to her report within the treatment plan. I am persuaded by Ms. Sharma’s report and the recommendations therein as they were corroborated by Ms. Baker and the respondent has not provided a compelling explanation as to why this treatment is not warranted. I accordingly find that the applicant has proven, on a balance of probabilities, that the treatment plan at issue (xvii) is reasonable and necessary.

88However, I am not convinced that further occupational therapy proposed in the treatment plan identified as issue (xviii) was reasonable and necessary.

89The applicant submits that the treatment plans are reasonable and necessary since the respondent obtained its own occupational therapy assessment, agreed based on the assessment that the applicant was entitled to attendant care benefits, and has continued to fund occupational therapy treatment. However, I am not persuaded that these treatment plans were necessarily reasonable and necessary in 2021 just because the respondent approved similar treatment and assessments after the applicant was removed from the MIG in 2023.

90Further, the applicant has not directed me to evidence that she received the proposed therapy or that it was helpful. If she did receive it, without being directed to any information as to its efficacy, I am not persuaded that a second round of occupational therapy was also reasonable and necessary around the time the treatment plan was submitted. Additionally, if the applicant did not receive the recommended occupational therapy, she has not explained why a second treatment plan was submitted or how it was not a duplication of services.

91In addition, the applicant has not explained why she required a second occupational therapy assessment less than one year after her assessment with Ms. Sharma. Given this lack of information, I find that she has not met her burden of proving, on a balance of probabilities, that a second occupational therapy assessment (issue (xix)) was reasonable and necessary around the time it was proposed.

92To summarize, I find that the applicant has proven, on a balance of probabilities, that the treatment plan identified as issue (xvii) is reasonable and necessary, but she has not met her burden for issues (xviii) or (xix).

OCF-3 (issue (iii))

93I find that the applicant is not entitled to payment for the OCF-3.

94Section 25(1)(1) of the Schedule states that an insurer shall pay reasonable fees charged for preparing a disability certificate if required under s. 21, 36, or 37.

95An OCF-3 was submitted by Dr. Chan, chiropractor, and is dated September 17, 2020. The OCF-3 in dispute was submitted by Dr. Kim and is dated November 2, 2020.

96The applicant submits that the expense for the OCF-3 was reasonable and necessary as it provided updated information regarding the applicant’s disability. However, the applicant has not explained how the submission of this second OCF-3 would have affected her entitlement to benefits under s. 21, 36, or 37 at the time, and has not provided evidence that an updated OCF-3 was requested by the respondent. Without this information, I find that the applicant has not proven on a balance of probabilities that this expense is payable.

OCF-6 (issue (xiii))

97I find that the applicant is entitled to the amount in dispute with respect to the OCF-6.

98The OCF-6 included expenses for Cyclobenzaprine, Nabilone, and Gabapentin. Dr. Kim prescribed Flexeril/Cyclobenzaprine on September 15, 2020. Dr. Behrouz prescribed Gabapentin on January 28, 2021, and Nabilone on April 15, 2021. These medications appear to have been prescribed to treat the applicant’s pain which began after the accident. The respondent has not pointed me to any evidence to the contrary. I am convinced that, on a balance of probabilities, these medications were reasonable and necessary expenses as a result of the accident.

99The respondent submits that the applicant has failed to produce evidence that she submitted these expenses through her extended health plan first, which would be the primary payor. However, it is clear from the receipts provided by the pharmacy and attached to the OCF-6 that the applicant paid only a portion of the cost of the medication out of pocket. Further, the respondent provided a copy of the medical claim history from Sun Life, the applicant’s extended health provider, and the dates and amounts on that document correspond with the receipts attached to the OCF-6. Based on the evidence before me, it appears that these expenses were already submitted to the applicant’s extended health plan and only the amounts that were not covered by Sun Life were submitted to the respondent.

100I accordingly find that the applicant is entitled to the amount in dispute with respect to the OCF-6.

Interest

101Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. I find that the applicant is entitled to interest on any overdue payment of the treatment plans that are payable pursuant to s. 38(11) and that are reasonable and necessary, as well as the OCF-6.

Award

102The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits. The bar for granting an award is high. The Tribunal has repeatedly held that an award is justified where insurer’s conduct was excessive, imprudent, stubborn, inflexible, unyielding or immoderate. The applicant has the onus of proving, on a balance of probabilities, that the respondent’s conduct justifies an award. For the following reasons, I find that the applicant is not entitled to an award.

103The applicant submits that the respondent improperly held her in the MIG despite being in possession of compelling medical evidence to the contrary, and that there was an unreasonable delay in her eventual removal from the MIG. She argues that within a year of the accident, she was diagnosed with a head injury, chronic pain, and psychological injuries, and was subsequently diagnosed with fibromyalgia. The applicant also submits that the respondent failed to explain why it favoured the opinions of s. 44 assessors over s. 25 assessors and treatment providers. She provided a list of the documentation she provided to the respondent, which she argues contained compelling medical evidence that she should have been removed from the MIG at an earlier date.

104I agree with the respondent that the records provided did not necessarily demonstrate a need for a removal from the MIG. As indicated above, Dr. Basile’s diagnosis of a head injury was not corroborated by the clinical notes and records. Further, prior to Dr. Ali’s assessment, the applicant has not directed me to clinical notes and records in the respondent’s possession that would have corroborated Ms. Aghamohseni’s diagnoses. Neither party provided me with the date that the records of Dr. Gantayet, who diagnosed fibromyalgia, were provided to the respondent; the applicant has accordingly not proven that the respondent had this information prior to her MIG removal.

105The applicant was diagnosed with chronic pain by two treating physicians, Dr. Seligman and Dr. Behrouz. These records contained within the clinical notes of Dr. Kim and were provided to the respondent on March 29, 2021. On April 12, 2021, Dr. Zabieliauskas conducted a s. 44 assessment. His report indicates that he reviewed records from Dr. Kim, but he did not specify a date range. It is unclear to me whether the records were provided to him. The applicant has not pointed me to compelling evidence that the respondent failed to provide these documents to Dr. Zabieliauskas or failed to consider them. I also note that a diagnosis of chronic pain alone does not necessarily immediately remove an insured from the MIG; there must also be a functional impairment associated with it. In my view, the respondent was not obligated to immediately remove the applicant from the MIG upon receipt of these documents. I am not convinced that after receiving these records, the respondent acted in a manner that was excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.

106The applicant also submits that the respondent failed to provide Dr. Zabieliauskas with an MRI dated May 31, 2021, which showed remote trauma involving the distal sacrum at the S5 segment with some healed bone deformity. She submits that Dr. Yee removed her from the MIG on that basis. However, Dr. Yee opined that there was a possibility of sacral deformity which would place her outside of the MIG, but he deferred comment until he had the opportunity to review the results of a CT scan. As such, I disagree with the applicant’s suggestion that she would have been removed from the MIG had this MRI report been provided to Dr. Zabieliauskas.

107It is well-settled that an insurer is not held to a standard of perfection in their adjusting decisions. Further, insurers are not medical professionals. Although I acknowledge that some aspects of the s. 44 reports of Dr. Patterson and Dr. Zabieliauskas were problematic, I am not persuaded that they contained such glaring errors that it was unreasonable for the respondent to have relied on them. Further, the applicant has not provided a compelling explanation as to why the respondent was obligated to accept the opinions of the s. 25 assessors over the s. 44 assessors.

108The applicant also argues that the respondent failed to reconsider previously denied treatment plans after her removal from the MIG. However, I agree with the respondent that this was not a situation where it stubbornly maintained a wrong conclusion. After the applicant was removed from the MIG, the respondent re-assessed some of the previously denied treatment plans. It also approved further treatment and attendant care. Although it did not re-assess some of the treatment plans, the applicant has not directed me to evidence or provided a compelling argument that this was done because the respondent was being excessive, imprudent, stubborn, inflexible, unyielding or immoderate.

109I accordingly find that the applicant has not met her burden in proving, on a balance of probabilities, that the respondent is liable to pay an award.

ORDER

110The applicant is entitled to the following treatment plans, plus applicable interest, as they are reasonable and necessary:

(i) $2,200.00 for a psychological assessment, proposed by Excel Medical Diagnostics in a treatment plan dated December 9, 2020 (issue (v));

(ii) $3,566.29 for psychological therapy, proposed by Excel Medical Diagnostics in a treatment plan dated March 22, 2021 (issue (x));

(iii) $3,566.29 for psychological treatments, proposed by Dr. Aghamohseni in a treatment plan dated July 7, 2021 (issue (xv));

(iv) $2,818.14 out of the $4,389.03 proposed by Dr. Sharma for psychological treatments in a treatment plan dated April 26, 2022 (issue (xxii)); and

(v) $7,407.03 for occupational therapy, proposed by Excel Medical Diagnostics in a treatment plan dated August 27, 2021 (issue (xvii)).

111The applicant is entitled to payment for the following treatment plans, plus applicable interest, by operation of s. 38(11), once incurred and properly invoiced:

(i) $3,696.50 for physical treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated September 17, 2020 (issue (i));

(ii) $1,998.80 for an occupational therapy assessment, proposed by Excel Medical Diagnostics in a treatment plan dated October 6, 2020 (issue (ii));

(iii) $1,300.00 for chiropractic treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated December 4, 2020 (issue (iv));

(iv) $2,026.55 for chiropractic treatments, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated January 11, 2021 (issue (vi));

(v) $2,292.43 for occupational therapy and assistive devices, proposed by Excel Medical Diagnostics in a treatment plan dated January 28, 2021 (issue (vii));

(vi) $2,632.85 for a physical assessment, proposed by Excel Medical Diagnostics in a treatment plan dated January 28, 2021 (issue (viii)); and

(vii) $1,417.70 for assistive devices, proposed by Excel Medical Diagnostics in a treatment plan dated February 2, 2021 (issue (xi)).

112The applicant is entitled to the cost of the items in dispute in the OCF-6 dated July 26, 2021 (issue (xiii)), plus interest.

113The applicant is not entitled to the remainder of the treatment plans in dispute or the cost of the OCF-3.

114The respondent is not liable to pay an award.