Licence Appeal Tribunal File Number: 24-007865/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:
Raymon Khan
Applicant
and
Intact Insurance Company
Respondent
DECISION
VICE-CHAIR: Robert Maich
APPEARANCES:
For the Applicant: Doina Marinescu, Paralegal
For the Respondent: Robbie Brar, Counsel
HEARD: In Writing
OVERVIEW
1Raymon Khan, the applicant, was involved in an automobile accident on June 9, 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, Intact Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2The applicant was a passenger in a 2015 Mercedes van driving westbound in the centre lane of Highway 401 near Markham Road, Toronto when a 2017 Nissan sedan travelling an estimated 110 km/h struck the rear-left corner of his vehicle, forcing it into the right lane where it was struck a second time.
ISSUES
3The issues in dispute are:
Is the applicant entitled to an income replacement benefit (“IRB”) in the amount of $400.00 per week from June 16, 2022 to June 9, 2024?
Is the applicant entitled to the assessments proposed by Q Medical, as follows:
i. $2,526.68 for a psychological assessment, in a treatment plan submitted on September 29, 2022;
ii. $895.10 ($2,540.81 less $1,645.71 approved) for a psychiatric assessment, in a treatment plan submitted on January 30, 2023; and
iii. $2,526.68 for a chronic pain assessment, in a treatment plan submitted on February 3, 2023?
- Is the applicant entitled to the assessment and treatment plan/OCF-18 (“treatment plan”) proposed by E Clinic United Healing (“ECUH”), as follows:
i. $1,050.00 for a nutritional assessment, in a treatment plan submitted on October 12, 2023;
ii. $50.30 ($2,444.15 less $1,945.13 approved) for psychological services, in a treatment plan submitted on March 2, 2023;
iii. $87.19 ($1,231.04 less $1,143.85 approved) for chiropractic services, in a treatment plan submitted on October 12, 2023;
iv. $1,478.67 ($3,423.80 less $1,945.13 approved) for psychological services, in a treatment plan submitted on December 18, 2023; and
v. $3,040.40 for psychological services, in a treatment plan submitted on May 13, 2024?
- Is the applicant entitled to the treatment plans proposed by Dynamic Balance Physio and Sports Care (“Dynamic”), as follows:
i. $1,796.00 for chiropractic services, in a treatment plan submitted on August 31, 2022; and
ii. $1,297.00 for chiropractic services, in a treatment plan submitted on October 11, 2022?
- Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4The applicant entitled to IRB in the amount of $400.00 per week from June 16, 2022 to June 30, 2023.
5The applicant is entitled to $2,526.68 for a psychological assessment, proposed by Q Medical in a treatment plan submitted on September 29, 2022.
6The applicant is entitled to $895.10 ($2,540.81 less $1,645.71 approved) for a psychiatric assessment, proposed by Q Medical in a treatment plan submitted on January 30, 2023.
7The applicant is entitled to $2,526.68 for a chronic pain assessment, proposed by Q Medical in a treatment plan submitted on February 3, 2023.
8The applicant is not entitled to $1,050.00 for a nutritional assessment, proposed by ECUH in a treatment plan submitted on October 12, 2023.
9The applicant is not entitled to $50.30 ($2,444.15 less $1,945.13 approved) for psychological services, proposed by ECUH in a treatment plan submitted on March 2, 2023.
10The applicant is not entitled to $87.19 ($1,231.04 less $1,143.85 approved) for chiropractic services, proposed by ECUH in a treatment plan submitted on October 12, 2023.
11The applicant is entitled to $938.67 ($3,423.80 less $1,945.13 approved less $540 ineligible fees) for psychological services, proposed by ECUH in a treatment plan submitted on December 18, 2023.
12The applicant is not entitled to $3,040.40 for psychological services, proposed by ECUH in a treatment plan submitted on May 13, 2024.
13The applicant is entitled to $1,796.00 for chiropractic services, as proposed by Dynamic in a treatment plan submitted on August 31, 2022.
14The applicant is entitled to $1,297.00 for chiropractic services, as proposed by Dynamic in a treatment plan submitted on October 11, 2022.
15The applicant is entitled to interest on any overdue payment of benefits in accordance with s. 51 of the Schedule.
ANALYSIS
Background
16The applicant submits that eight days following the accident on June 17, 2022, he attended urgent care complaining of neck, mid- and low-back pain, left-shoulder pain, headaches, and ringing in both ears; physical examination noted thoracic paraspinal spasm and restricted left-shoulder range of motion; diagnostic imaging was ordered. The applicant reported no previous motor vehicle accidents and denied any pre-existing issues with his neck, back or joints.
17The applicant was self-employed for approximately 5 years preceding the accident, as an importer and retailer of custom-made baskets (called Bolga Baskets) that he imported from Ghana and sold at various markets.
IRB
18The applicant is entitled to an income replacement benefit in the amount of $400.00 per week from June 16, 2022 to June 30, 2023.
19To receive payment for an IRB under s. 5(1) of the Schedule, the applicant must be employed at the time of the accident and, as a result of and within 104 weeks after the accident, suffer a substantial inability to perform the essential tasks of that employment. The applicant must identify the essential tasks of their employment, which tasks they are unable to perform and to what extent they are unable to perform them. The applicant bears the burden of proving, on a balance of probabilities, that they meet the test.
20The applicant relies on the Disability Certificate (OCF-3) dated February 17, 2023 completed by Mr. Rambukkana, physiotherapist, which he submits established his entitlement to IRB from June 16, 2022 to June 9, 2024 as Mr. Rambukkana concluded that the applicant is “substantially unable” to carry out his pre-accident work and predicts disability for more than 12 weeks. The insurer retained Mr. Dydula, kinesiologist for a Physical Demands Analysis (“PDA”) dated June 30, 2023 to measure the applicant’s job demands. Mr. Dydula that found operating Bolga Baskets requires erecting tents and racks and occasionally lifting up to 30 lb above shoulder level, plus prolonged driving to markets. Mr. Dydula further performed a Functional Abilities Evaluation (“FAE”) dated June 30 2023 and found left-shoulder flexion of 82 degrees (less than half of normal), lumbar extension of 1 degree, and a safe lift tolerance of only 25 lb from waist to shoulder despite valid effort.
21Further, the applicant relies on the insurer’s musculoskeletal paper review by Dr. Silver, physician, dated June 30, 2023 of the Musculoskeletal Assessment Reports (“MAR”) dated December 15, 2022 completed by Dr. Belfon, physician, and the MAR dated March 30, 2023 completed by Dr. Silver. Both concluded that the applicant remained substantially unable to perform the essential duties of his regular employment. Neither assessor found the applicant can perform overhead lifting and set-up demands as identified in the PDA, nor found causation of the applicant’s impairments being from the accident to be in dispute.
22The respondent submitted that the applicant is unable to substantially perform only one out of many of his essential pre-accident employment tasks, specifically setting up and taking down the tents and racks for his business setup in various markets. Further, the insurer submitted that the applicant is able to continue his job on modified duties, completing most of the essential tasks of his self-employment with assistance from family for the only task he is unable to perform. The respondent also submitted the set up and take down of the tents and racks cannot be reasonably viewed as the primary task for his self-employed business; the respondent relies upon Thiab v. Economical Mutual Insurance Company, 2024 CanLII 15977 (ON LAT) for this position.
23I find the submissions of the applicant to be persuasive, in part. I find it clear from the evidence of Dr. Silver, Dr. Belfon, Mr. Dydula and Mr. Rambukkanan that the applicant could not perform over-head lifting and set up demands of his business from the date of the accident to at least June 30, 2023, the last date of supportive evidence. I do not accept the respondent’s submission that the applicant was only limited to the set up and take down function of his business, as the evidence is clear the applicant was unable to perform overhead lifting identified in the PDA.
24I find that the applicant was self-employed and physically setting up his business is fundamental to it as a pre-condition to generating business revenue. I find that a self-employed person with no employees is not a suitable candidate for modified duties as there is no possibility to re-assign essential and necessary tasks. I find that the set up and takedown of the applicant’s business is an essential task of his self-employment under s.5(1) of the Schedule.
25Further, I find the applicant provided no evidence that his inability to work extended beyond the last assessment of June 30, 2023. I note there is no evidence that the applicant’s situation would improve, however, it is the onus of the applicant to demonstrate that the disability is ongoing.
26I find the respondent’s assertion that the applicant could operate his business with the unpaid assistance of family to be unacceptable, as no person may be obligated or expected to work without compensation in the province of Ontario and throughout Canada.
27The applicant is entitled to IRB in the amount of $400.00 per week from June 16, 2022 to June 30, 2023.
Is the applicant entitled to the assessments proposed by Q Medical:
i $2,526.68 for a psychological assessment?
28The applicant is entitled to $2,526.68 for a psychological assessment, proposed by Q Medical in a treatment plan submitted on September 29, 2022.
29Pursuant to section 15 of the Schedule, the respondent is liable to pay for all reasonable and necessary expenses incurred by or on behalf of the insured persons a result of an accident. It is the applicant’s responsibility to prove the medical benefits claimed are reasonable and necessary on a balance of probabilities.
30The purpose of an assessment is to determine whether a condition exists. For an insured, they bear the onus to demonstrate that there are grounds on which to believe that a condition exists that would warrant further investigation by way of an assessment.
31The applicant submitted that three months after the accident, he was reporting insomnia, intrusive thoughts while driving, and growing avoidance of highway travel; these symptoms were noted in urgent-care records of June 17, 2022 as evidenced in the clinical notes and records of Dr. Sivaharan, physician, and the physiotherapy intake records of Dynamic dated August 23, 2022. The goal of the psychological assessment was to determine whether the complaints constituted an accident-related DSM-5 disorder and if necessary, propose an evidence-based treatment plan.
32Further, the applicant submitted he completed a psychological assessment by Dr. Toneatto, psychologist, dated December 22, 2022 and was diagnosed with Somatic Symptom Disorder (“SSD”), specific phobia driving and adjustment disorder; Dr. Toneatto recommended 12 to16 sessions of cognitive behavioural therapy. The applicant submitted he was removed from the MIG on April 18, 2023. The applicant also submitted is was in compliance with s.33 at all times
33The respondent maintained that the assessment was not reasonable or necessary as the psychiatry evaluation by Dr. Wiseman, psychiatrist, dated March 30, 2023 served the function of a psychological assessment and the approval of the assessment would be duplicative of work already completed. Further, the respondent maintained the MIG as a reason for denial of the assessment as well as s.33 non-compliance but did not provide details for its s.33 non-compliance submission.
34I find the submissions of the applicant to be persuasive, I find the psychological assessment proposed by the applicant to be reasonable and necessary as evidenced by the notes of Dr. Sivaharan and Dynamic, which indicated further investigation was reasonable.
35I find the respondent’s submission that the psychological assessment would be duplicative of the psychiatric evaluation by Dr. Wiseman dated March 30, 2023 to be unpersuasive because Dr. Wiseman’s evaluation was completed three months subsequent to the psychological assessment of Dr. Toneatto. Further, I find the respondent maintained the MIG as the reason for the denial as stated in the notice’s notice of denial letter dated October 5, 2022. The respondent has now shifted its reasons for the denial to be the assessment was not reasonable or necessary; I do not find this submission to be persuasive in the face of the applicant’s evidence provided in the notes of Dr. Sivaharan and Dynamic.
36The applicant is entitled to $2,526.68 for a psychological assessment, proposed by Q Medical in a treatment plan submitted on September 29, 2022.
ii $895.10 ($2,540.81 less $1,645.71 approved) for a psychiatric assessment?
37I find the applicant entitled to $895.10 ($2,540.81 less $1,645.71 approved) for a psychiatric assessment, proposed by Q Medical in a treatment plan submitted on January 30, 2023.
38The applicant submitted that the psychological assessment by Dr. Toneatto, dated December 22, 2022 identified and supported treatment with psychological services recommending approximately 12 to 16 one hour sessions and a formal psychiatric assessment to explore pharmacological options. The applicant submitted this is sufficient evidence to establish the treatment plan is reasonable and necessary further investigation is warranted. The applicant also submitted the respondent’s assessor Dr. Wiseman, in his March 30, 2023 report recommended a medication review.
39The respondent submitted the treatment plan was partially approved for 10 hours for assessment, with further adjustment to be made, based on the March 30, 2023 psychiatry report of Dr. Wiseman.
40I note that the respondent initially denied the treatment plan in its entirety under the MIG as detailed in the insurer’s notice of denial letter dated February 24, 2023. Further I find the insurer scheduled examinations to address the treatment plan resulting in the March 30, 2023 report of Dr. Wiseman. I find the respondent’s decision to undertake a psychiatric assessment is evidence further investigation is reasonable and warranted. Further, I find that the respondent may not limit assessments to its own assessors and deny the applicant the opportunity for independent assessment that may vary in its findings and conclusions. I find the respondent’s denial of benefit and submission that an independent assessment would be duplicative would have the net effect of limiting and controlling the evidentiary record to expert opinions of the respondent’s choosing.
41In respect to the time required t complete the assessment, I note Dr. Wiseman did not offer a reason why the psychological assessment should be completed in 10 hours. I take notice that physiatry and psychology are different disciplines and specialties of practice, albeit with some overlap. I find no reason to prefer the opinion of a psychiatrist over the opinion of a psychologist in the design of a psychological assessment and treatment plan, as it lies clearly within the purview of a treating clinical psychologist. I am inclined to prefer the evidence of a treating clinical psychologist when determining a psychological assessment and treatment plan.
42I find the applicant met his burden that the treatment plan is reasonable and necessary as evidenced by the recommendation for psychiatric assessment in the psychological assessment of Dr. Toneatto. I do not find the respondent’s rebuttal to be persuasive as I have not been directed to any medical evidence or medical reason to vary from the recommendations of Dr. Toneatto. Absent any medical evidence, I find the position of the respondent was not persuasive.
43I find the applicant entitled to $895.10 ($2,540.81 less $1,645.71 approved) for a psychiatric assessment, proposed by Q Medical in a treatment plan submitted on January 30, 2023.
iii $2,526.68 for a chronic pain assessment?
44I find the applicant is entitled to $2,526.68 for a chronic pain assessment, proposed by Q Medical in a treatment plan submitted on February 3, 2023.
45The applicant submitted it is reasonable to further investigate and evaluate whether his accident-related pain has evolved into a chronic-pain condition and to generate a coordinated treatment plan. The applicant submitted that the more than two years’ worth of clinical material support that the assessment is reasonable and necessary. The applicant points to the weekly physiotherapy notes as evidence that despite three completed blocks of physiotherapy and a rigorous home-exercise programme, the applicant’s neck, low-back and left-shoulder pain never improved past a 50% functional level; the treating therapists documented sleep disruption, early-morning stiffness and an inability to load market stock without help. Further, objective findings in diagnostic imaging demonstrated left-shoulder tendinosis, tenosynovitis and impingement, early gleno-humeral osteoarthritis and lumbar degenerative change. The applicant also submitted that the insurer’s FAE found left-shoulder flexion of 82° and safe waist lift tolerance of 25 lbs; it also validates effort at 88%, eliminating malingering as an explanation.
46The respondent directed the Tribunal to IE reports at Tabs 18, 19 and 26 as well as correspondence at Tabs 11, 24 and 27; the respondent submitted it repeats the findings of the IE reports especially the clarification report of Dr. Wiseman I find the respondent made no submissions in respect to this issue as it merely pointed the Tribunal to over 100 pages of documents without any specific evidentiary points or references, absent any articulated specific evidence, submissions or legal precedent.
47I find the submissions of the applicant to be persuasive as the evidence of the applicant’s post-accident pain and limitations are substantial despite physiotherapy treatment with limited results. I find it is reasonable to investigate the prevalence of pain further through a chronic pain assessment.
48I find the applicant is entitled to $2,526.68 for a chronic pain assessment, proposed by Q Medical in a treatment plan submitted on February 3, 2023.
Is the applicant entitled to the assessment and treatment plans proposed by ECUH as follows:
i. $1,050.00 for a nutritional assessment, in a treatment plan submitted on October 12, 2023?
49I find that the applicant is not entitled to $1,050.00 for a nutritional assessment, in a treatment plan submitted on October 12, 2023.
50The applicant made no submissions in regard to this treatment plan, nor did the applicant withdraw the issue in dispute.
51The respondent submitted it relied upon the reasoning in its notice of denial which found after an examination of the applicant on December 6, 2023 by Ms. Rolph, registered dietician, that the applicant’s weight gain was marginal; his pre-accident weight range was 165-175lbs; he weighed 167lbs at the time of examination and peaked at 178lbs post-accident. Ms. Rolph found the applicant’s eating and nutritional habits did not change post-accident and did not warrant a nutritional plan or assessment.
52I find the applicant has not met his onus of proof. My conclusion is further buttressed by the persuasive submissions of the respondent.
53I therefore find that the applicant is not entitled to $1,050.00 for a nutritional assessment, in a treatment plan submitted on October 12, 2023.
ii. $50.30 ($2,444.15 less $1,945.13 approved) for psychological services, in a treatment plan submitted on March 2, 2023?
54I find the applicant is not entitled to $50.30 ($2,444.15 less $1,945.13 approved) for psychological services, in a treatment plan submitted on March 2, 2023.
55The applicant made no submissions in regard to this treatment plan, nor did the applicant withdraw the issue in dispute.
56The respondent submitted it repeated the findings at tabs 9, 22, 27 and 30 and made no pinpoint references or submissions.
57I find the applicant did not meet his onus that the unapproved balance of the treatment plan is reasonable and necessary, nor did the applicant rebut the fee adjustments made by the respondent.
58Without any specific submissions by the applicant or being directed to evidence in support of the unapproved portion of the treatment plan, I find the applicant is not entitled to $50.30 ($2,444.15 less $1,945.13 approved) for psychological services.
iii. $87.19 ($1,231.04 less $1,143.85 approved) for chiropractic services, in a treatment plan submitted on October 12, 2023?
59I find the applicant is not entitled to $87.19 ($1,231.04 less $1,143.85 approved) for chiropractic services, in a treatment plan submitted on October 12, 2023.
60The applicant made no submissions in regard to this treatment plan, nor did the applicant withdraw the issue in dispute.
61The respondent submitted the treatment plan was partially approved and that the fee adjustments are supported by the FSCO guidelines; the respondent made no pinpoint references or submissions. I note that the FSCO guidelines have been adopted by its successor agency, the Financial Services Regulatory Authority (FSRA).
62I find the applicant did not meet his onus that the denied portion of the treatment plan was reasonable and necessary nor did the applicant rebut the fee adjustments made by the respondent.
63I find the applicant is not entitled to $87.19 ($1,231.04 less $1,143.85 approved) for chiropractic services, in a treatment plan submitted on October 12, 2023.
iv. $1,478.67 ($3,423.80 less $1,945.13 approved) for psychological services, in a treatment plan submitted on December 18, 2023?
64I find the applicant is entitled to $938.67 in addition to the amounts previously approved for psychological services in a treatment plan submitted December 18, 2023. The applicant is not entitled to the remaining balance of $540 in ineligible fees.
65The applicant submitted he was diagnosed with SSD and specific driving phobia as well as adjustment disorder by Dr. Toneatto, who recommended 12 to 16 sessions of cognitive behavioural therapy. Further, the applicant submitted that the insurer’s psychiatrist made the same findings and endorsed the same course of cognitive behavioural therapy. The applicant also submitted the partial approvals concede both diagnosis and need, but the respondent arbitrarily trimmed hourly rates and documentation time from psychological services that both Dr. Toneatto and Dr. Wiseman find to be necessary treatments. Further, the applicant submitted the proposed $149–$158 hourly fees and one-to-two admin hours is within the FSRA Professional Services Guideline.
66The respondent submitted the treatment plan was partially approved and that the fee adjustments are supported by the FSCO guidelines; the respondent made no pinpoint references or submissions and referred the Tribunal generally to the FSCO guidelines.
67I find the parties have agreed the treatment plan was reasonable and necessary with the issue of permitted costs remaining in dispute. I find upon review of the FSCO guidelines that the proposed psychologist rate of $149 to $158 is within the permitted rate under the guidelines and the applicant is entitled to his health care professional of his choice within the prescribed range. I find this range is established to recognize the varying rates between health care providers, as it is not permissible for health care providers to publish an insured rate and an uninsured rate.
68I find that in regard to documentation that the guidelines permit a $200.00 documentation fee, and the proposal treatment plan included an additional $540.00 documentation fee that is not permitted under the guidelines. The applicant has not proven his entitlement to the $540. I find $540.00 deducted from the amount in dispute of $1,478.67 results in an entitlement to the applicant of $938.67 in addition to the amounts previously approved.
69I find the applicant is entitled to $938.67 ($3,423.80 less $1,945.13 approved and less $540.00 ineligible fees) for psychological services, proposed by ECUH in a treatment plan submitted on December 18, 2023.
v. $3,040.40 for psychological services, in a treatment plan submitted on May 13, 2024?
70I find the applicant is not entitled to $3,040.40 for psychological services, in a treatment plan submitted on May 13, 2024.
71The applicant’s submissions for this issue were combined with the submissions for the previous issue and are the same as previously outlined in paragraph [63] above.
72The respondent submitted the psychology paper review report by Dr. Saghatoleslami, psychologist, dated June 24, 2024 identified substantial psychological treatment previously approved that has not been accessed by the applicant. The applicant did not provide any submissions refuting the respondent’s argument that prior approved treatment has not been accessed.
73I find the submissions of the respondent to be persuasive, as I find the applicant has not utilized the previously approved treatment plans. The treatment plans previously approved addressed the applicant’s needs at the time; approved treatment plans are medical benefits for the treatment and recovery goals of the insured. I find that the applicant’s decision not to access previously approved treatment plans, works against the applicant’s onus to prove the treatment plan is reasonable and necessary. I find the applicant did not meet his onus in respect to this plan.
74I find the applicant is not entitled to $3,040.40 for psychological services proposed in this treatment plan.
Is the applicant entitled to the treatment plans proposed by Dynamic as follows: i. $1,796.00 for chiropractic services, in a treatment plan submitted on August 31, 2022; and ii. $1,297.00 for chiropractic services, in a treatment plan submitted on October 11, 2022?
75I find the applicant is entitled to $1,796.00 for chiropractic services, in a treatment plan submitted on August 31, 2022 and $1,297.00 for chiropractic services, in a treatment plan submitted on October 11, 2022.
76The applicant submitted both treatment plans include physiotherapy and supervised exercise therapy with the goals of restoring cervical, thoracic, lumbar and left-shoulder function. Further, the applicant submitted the need is supported by urgent-care notes of June 17, 2022 that document thoracic paraspinal spasm and restricted shoulder range, the August 23, 2022 initial spinal assessment at Dynamic that note constant neck-to-shoulder pain rated 6/10, adhesive-capsulitis-level stiffness, and headaches as well as diagnostic imaging ordered in August 2022. The applicant also submitted physiotherapy produced only marginal gains as evidenced in progress notes between October 2022 and February 2023. Further, the insurer’s FAE reported June 30, 2023 confirms the lack of progress finding measured left-shoulder flexion at 82° (less than half normal) and lumbar extension at 1°; these deficits interfered with the 30-lb, above-shoulder lifts and prolonged driving identified in the PDA report dated June 30, 2023. The applicant also submitted the respondent denied these treatment plans on the basis of the MIG, however the respondent removed the applicant from the MIG on April 18, 2023. In addition, the applicant submitted the respondent’s MIG denial violated s.38(8) of the Schedule.
77The respondent submitted the denials of the treatment plans were addressed by IE reports while the applicant was still within the MIG. Further, the respondent submitted the applicant was removed from the MIG due to psychological impairments and only treatment plans relating to psychological impairments necessarily warrant further treatment; the does not preclude other types of treatment plans, however compelling evidence must be produced to establish the plans are reasonable and necessary. The respondent submitted the applicant has not provided compelling evidence to warrant that the specific treatment plans in dispute are reasonable and necessary, and that the goals of the treatment plans are reasonable and necessary for treatment of the accident-related impairments; the respondent relies upon Blas v Aviva Insurance Canada, 2021 CanLII 127471.
78I find that the applicant has demonstrated that the goals of the treatment plans, restoring cervical, thoracic, lumbar and left-shoulder function, relate to impairments attributed to the accident. I find that the medical evidence of the FAE and PDA support these goals as reasonable and necessary. I find for the above stated reasons that the applicant has met his onus.
79I find the applicant is entitled to 1,796.00 for chiropractic services, in a treatment plan submitted on August 31, 2022 and $1,297.00 for chiropractic services, in a treatment plan submitted on October 11, 2022.
Interest
80Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.
ORDER
81The Tribunal’s final Orders:
i. The applicant is entitled to an income replacement benefit in the amount of $400.00 per week from June 16, 2022 to June 30, 2023.
ii. The applicant is entitled to $2,526.68 for a psychological assessment, proposed by Q Medical in a treatment plan submitted on September 29, 2022.
iii. The applicant entitled to $895.10 ($2,540.81 less $1,645.71 approved) for a psychiatric assessment, proposed by Q Medical in a treatment plan submitted on January 30, 2023.
iv. The applicant is entitled to $2,526.68 for a chronic pain assessment, proposed by Q Medical in a treatment plan submitted on February 3, 2023.
v. The applicant is not entitled to $1,050.00 for a nutritional assessment, proposed by ECUH in a treatment plan submitted on October 12, 2023.
vi. The applicant is not entitled to $50.30 ($2,444.15 less $1,945.13 approved) for psychological services, proposed by ECUH in a treatment plan submitted on March 2, 2023.
vii. The applicant is not entitled to $87.19 ($1,231.04 less $1,143.85 approved) for chiropractic services, proposed by ECUH in a treatment plan submitted on October 12, 2023.
viii. The applicant is entitled to $938.67 ($3,423.80 less $1,945.13 approved and less $540.00 ineligible fees) for psychological services, proposed by ECUH in a treatment plan submitted on December 18, 2023.
ix. The applicant is not entitled to $3,040.40 for psychological services, proposed by ECUH in a treatment plan submitted on May 13, 2024.
x. The applicant is entitled to $1,796.00 for chiropractic services, as proposed by Dynamic in a treatment plan submitted on August 31, 2022.
xi. The applicant is entitled to $1,297.00 for chiropractic services, as proposed by Dynamic in a treatment plan submitted on October 11, 2022.
xii. The applicant is entitled to interest on any overdue payment of benefits.
Released: February 27, 2026
__________________________
Robert Maich
Vice-Chair