Licence Appeal Tribunal File Number: 24-014492/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:
Cecile Bemister
Applicant
and
Co-operators General Insurance Company
Respondent
DECISION
ADJUDICATOR:
Amar Mohammed
APPEARANCES:
For the Applicant:
Elena Pelz, Counsel
For the Respondent:
Emily Schatzker, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Cecile Bemister, the applicant, was involved in an automobile accident on August 26, 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, 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 $785.16 ($3,080.00 less $2,294.84 approved) for physiotherapy services, proposed by Mackenzie Medical in a treatment plan/ OCF-18 (“treatment plan”), partially denied September 20, 2022?
ii. Is the applicant entitled to $1,628.96 ($2,760.00 less $1,131.04 approved) for physiotherapy services, proposed in a treatment plan by Mackenzie Medical, partially denied November 2, 2022?
iii. Is the applicant entitled to $3,767.00 ($5,360.72 less $1,593.30 approved) for assistive devices, proposed in a treatment plan by Imperial Medical, partially denied October 6, 2022?
iv. Is the applicant entitled to $396.00 ($490.40 less $94.90 approved) for assistive devices, proposed in a treatment plan by Imperial Medical, partially denied October 6, 2022?
v. Is the applicant entitled to $533.52 ($2,354.49 less $1,820.97 approved) for physiotherapy services, proposed in a treatment plan by Mackenzie Medical, partially denied April 24, 2023?
vi. Is the applicant entitled to $219.48 ($2,188.79 less $1,969.28 approved) for physiotherapy services, proposed in a treatment plan by Mackenzie Medical, partially denied August 10, 2023?
vii. Is the applicant entitled to $492.48 ($2,188,79 less $1,696.28) for physiotherapy services, proposed in a treatment plan by Mackenzie Medical, partially denied October 12, 2023?
viii. Is the applicant entitled to $492.48 ($2,188,79 less $1,696.28) for physiotherapy services, proposed in a treatment plan by Mackenzie Medical, partially denied June 22, 2023?
ix. Is the applicant entitled to $1,525.84 for chiropractic services, proposed in a treatment plan by Mackenzie Medical, denied February 23, 2024?
x. Is the applicant entitled to $2,188.76 for physiotherapy services, proposed in a treatment plan by Mackenzie Medical, denied September 24, 2024?
xi. Is the applicant entitled to $412.22 ($3,155.59 less $2,743.27 approved) for psychological services, proposed in a treatment plan by Imperial Medical, partially denied December 28, 2023?
xii. Is the applicant entitled to $1,284.92 ($2,856.37 less $1,571.45 approved for psychological services, proposed in a treatment plan by Imperial Medical, partially denied June 5, 2024?
xiii. Is the applicant entitled to $6,260.00 ($8,361.00 less $2,101.00 approved) for optometric services, proposed in a treatment plan by Erin Haney Optometry, partially denied October 16, 2024?
xiv. Is the applicant entitled to attendant care benefits in the amount of $10,397.69 per month for the period September 2022 to October 2022 denied January 9, 2023?
xv. Is the respondent (insurer) entitled to a repayment of $5,009.50 relating to its payment of income replacement benefits for the period of September 3, 2022 to March 24, 2023?
xvi. Is the applicant entitled to interest on any overdue payment of benefits?
3The parties confirmed that a number of issues listed in the Case Conference Report and Order (“CCRO”) were no longer in dispute. I have not included those issues in the list above.
RESULT
4The applicant is entitled to 16 instances of travel costs for massage therapy at $58.19 each, for a total cost of $931.04. The applicant is not entitled to the rest of this partially approved plan for physiotherapy services.
5The applicant is not entitled to the remainder of the disputed amounts for the treatment plans in dispute.
6There is no basis to make an Order for attendant care benefits for the period September-October 2022.
7The applicant is entitled to interest pursuant to s. 51 of the Schedule.
8Since there is no longer a dispute before me as to repayment of $5,009.50 as set out below, an order is not warranted.
ANALYSIS
i. Is the applicant entitled to $785.16 ($3,080.00 less $2,294.84 approved) for the treatment plan for physiotherapy services?
9I find that the applicant is not entitled to the balance of $785.16 ($3,080.00 less $2,294.84 approved) for the treatment plan for physiotherapy services.
10To 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.
11The amount of $785.16 in dispute relates to the following:
i. 18 sessions by a registered massage therapist, $16.81 ($75.00 less $58.19 approved).
ii. 18 instances of provider travel time by a registered massage therapist, $16.81 ($75.00 less $58.19 approved).
iii. 18 instances of gloves/protective by registered massage therapist at $10.00 each for total cost of $180.00.
12The applicant’s submissions withdrew the claim for the increased hourly rate applicable to the massage therapist and the claim for protective gloves. However, the applicant’s position is that this issue is still in dispute because she is claiming entitlement to 18 instances of travel costs by the provider.
13The respondent argues that this claim should be dismissed because 18 instances of travel costs were already approved at the lower rate, and the higher rate is no longer in dispute.
14A review of the respondent’s September 20, 2022 correspondence indicates that it approved the travel costs of the massage therapist as noted above. Since the hourly rate and the protective gloves are no longer in dispute, I find that the applicant is not entitled to the remaining balance.
15I find that the applicant is not entitled to $785.16 ($3,080.00 less $2,294.84 approved) for physiotherapy services.
ii. Is the applicant entitled to $1,628.96 ($2,760.00 less $1,131.04 approved) for the treatment plan for physiotherapy services?
16I find that the applicant is entitled to 16 instances of travel costs for the massage therapist at $58.19 each, for a total of $931.04 of the treatment plan.
17The amount of $1,628.96 in dispute relates to the following:
i. 16 sessions by a registered massage therapist, $16.81 ($75.00 less $58.19 approved).
ii. 16 instances of provider travel time by a registered massage therapist, $75.00.
iii. 16 instances of gloves/protective by registered massage therapist at $10.00 each for total cost of $160.00.
18The applicant withdrew her claim for the increased hourly rate and the protective gloves as reviewed in addressing the prior plan in dispute. Accordingly, the applicant’s claim is narrowed to 16 instances of travel costs for the massage therapist at the lower rate of $58.19 each, for a total cost of $931.04. The dispute between the parties is limited to the narrow question of whether the medical evidence continued to support the applicant’s position that she was unable to attend in-facility-based treatment.
19The applicant argues that she was bedridden, non-weight-bearing on her foot, unable to ambulate and to drive at the time this plan was proposed, two months post-accident. The applicant’s position is that, at the time of this treatment plan, she was essentially in the same position as she was two weeks post-accident when the respondent approved the travel costs proposed in the prior plan noted above.
20The respondent’s position is that it did not have medical documentation to support that the applicant is unable to attend in-facility-based treatment, as noted in its denial notice dated November 2, 2022. The respondent refers to the clinical notes and records (“CNRs”) of Dr. David Wasserstein, orthopedic surgeon, on October 17, 2022, noting he had switched her to an aircast boot and recommended that she be weightbearing as tolerated while on crutches, and to engage in gait training. Further, the respondent submits, the CNRs of the applicant’s in-home physiotherapy provider noted on October 31, 2022 that she was taking steps without her crutches during physiotherapy.
21I find that the CNRs of Dr. Wasserstein note that the applicant’s visit was a follow-up to the fracture clinic due to left ankle trimalleolar fracture and that she had surgery on August 27, 2022. While Dr. Wasserstein notes that she is encouraged to be weight-bearing as tolerated while on crutches, it is also noted that she can wean off the crutches when she is able to do so to her satisfaction, giving the applicant some discretion over her comfort level and ability to function during this period. Dr. Wasserstein prescribed physiotherapy for stretching and gait training and scheduled a follow up 6 weeks after the visit on October 17, 2022. Dr. Wasserstein did not discharge the applicant from the fracture clinic until July 31, 2023.
22The respondent accepts in submissions that the applicant sustained “a left tibia/fibula and ankle fracture, multiple right-side rib fractures, a soft tissue hematoma in her pelvis, and a superior endplate compression fracture of T11” as a result of the accident. The CNRs of the applicant’s in-home physiotherapy session, dated October 31, 2022, indicate some progress. However, in my view, taking a few steps at home during a physiotherapy session is not indicative of the applicant being able to immediately attend in-facility treatment. This is particularly the case as the respondent accepted that she could not do so up to that point and had approved travel expenses accordingly at the reduced rate acceptable to it, which the applicant does not contest.
23For the reasons above, on a balance of probabilities, I find that the applicant is entitled to 16 instances of travel costs for the massage therapist at $58.19 each, for a total cost of $931.04.
iii. Is the applicant entitled to $3,767.00 ($5,360.72 less $1,593.30 approved) for the treatment plan for assistive devices, proposed by Imperial Medical, partially denied October 6, 2022?
24I find that the applicant is not entitled to the $3,767.00 ($5,360.72 less $1,593.30 approved) for assistive devices in the treatment plan.
25This plan was received by the respondent on September 30, 2022. The respondent denied:
i. $200.00 plus tax for administration,
ii. $2899.00 plus tax for an electric lift sofa chair recliner,
iii. $200.00 plus tax for delivery, and
iv. $460.00 plus tax for a light weight transport chair.
26The applicant did not address the administration cost or the delivery charges in her submissions.
27The applicant argues that the electric lift sofa chair recliner was reasonable and necessary due to the applicant’s significant difficulty with transitioning from sitting to standing. The applicant argues it was the safest and most effective option to promote safe transfers at the time. She further argues that the transport chair was reasonable and necessary because the applicant could not walk due safely for prolonged periods due to the injuries she sustained, her ankle surgery, and had post-concussion symptoms.
28The respondent argues it is not liable for these expenses because according to an OCF-21 dated November 15, 2022, the expenses were incurred on September 2, 2022, prior to the underlying plan being submitted to the respondent on September 30, 2022.
29Since s. 38(2) of the Schedule states that the respondent is not liable for expenses that are incurred prior to the submission of a plan, and the applicant has not addressed if she meets any of the exceptions that apply, I find that the applicant is not entitled to the balance of this plan.
30For the reasons above, on a balance of probabilities, I find that the applicant is not entitled to the $3,767.00 ($5,360.72 less $1,593.30 approved) for assistive devices.
iv. Is the applicant entitled to $396.00 ($490.40 less $94.90 approved) for the treatment plan for assistive devices, proposed by Imperial Medical, partially denied October 6, 2022?
31I find that the applicant is not entitled to the $396.00 disputed for this plan.
32This plan was received by the respondent on September 30, 2022. The respondent denied:
i. $150.00 plus tax for administration
ii. $200.00 plus tax for completion of the OCF-18 form
33The respondent approved the following proposed assistive devices:
i. $59.99 for leg elevation pillow memory foam,
ii. $23.99 for wrist brace carpel tunnel, and
iii. $10.92 for applicable tax.
34The applicant did not address the denied portion of this plan and has therefore not met her onus in establishing it is reasonable and necessary.
35For the reasons above, on a balance of probabilities, I find that the applicant is not entitled to the $396.00 disputed for this plan.
v.-viii. Is the applicant entitled to the treatment plans for $533.52 ($2,354.49 less $1,820.97 approved), $219.48 ($2,188.79 less $1,969.28 approved), $492.48 ($2,188,79 less $1,696.28), and $492.48 ($2,188,79 less $1,696.28) for physiotherapy services, proposed by Mackenzie Medical?
36I find that the applicant is not entitled to the partial amounts disputed for these plans.
37The applicant’s submissions only address the denial of 0.33 hours of physiotherapy at a cost of $19.20 per session, with 12 or 13 sessions proposed on each of the plans in dispute. The applicant argues this treatment was reasonable and necessary in addition to the other treatment sessions approved by the respondent, proposed within the same plans, to allow more time for the treatment provider during each session.
38The applicant refers me to CNRs from the fracture clinic in July 2023 where she complained of pain. This reference does not address the additional and separately proposed 0.33 hours of physiotherapy in these plans. The applicant’s submissions do not refer me to any evidence that this separately proposed treatment was reasonable and necessary. Since submissions are not evidence, the applicant has not met her onus in establishing these portions of the plans are reasonable and necessary.
39For the reasons above, on a balance of probabilities, I find that the applicant is not entitled to the partial amounts disputed for these plans.
viii.-x. Is the applicant entitled to the treatment plans for $1,525.84 for chiropractic services, denied February 23, 2024; and $2,188.76 for physiotherapy services denied September 24, 2024, proposed by Mackenzie Medical?
40I find that the applicant is not entitled to the plans in dispute.
41The parties have addressed the two plans together in their submissions. A review of the plans indicates that the plan proposing $1,525.84 in services lists a physiotherapist as the health care provider. The plan proposing $2,188.76 in services lists a physiotherapist and a massage therapist as the health care providers.
42Both plans detail the line items being proposed in the additional comments section. The line items are described to be identical between the two plans. The plans propose the following: Treatment sessions, manual therapy, mobilization, physical therapy, IFC, TENS, electrotherapy, heat pack, ice pack, acupuncture, active therapy, reassessment, massage treatment, personal protective equipment. The goals are pain reduction, increase in range of motion and strength, and a return to both activities of normal living and pre-accident work activities.
43The applicant argues the two plans are reasonable and necessary because treating practitioners consistently recommended continued therapy. Further, that the s. 44 Physiatry Assessment by Dr. Mohammed Abdul Wahab Khan, physiatrist, dated May 24, 2024 confirmed reduced range of motion in her lumbar spine and left ankle, positive orthopedic tests including Kemp’s, FABER, Thomas, and SI compression, and accepted that she had met the criteria for chronic pain syndrome. The applicant argues that pain relief is a reasonable and necessary goal identified in the plans in addition to improving range of motion and increasing strength. The applicant submits that her symptoms worsened as she transitioned to hybrid work shifts, with increased swelling after 8-hour shifts, and that there were new symptoms including numbness and tingling that required continued treatment. Subsequently, the applicant had left ankle arthroscopic surgery in March 2025 that she submits is evidence that she required continuing physiotherapy treatment.
44The applicant refers me to a CNR of Dr. Krystyna Prutis, MD, PhD, FRCPC, completed on November 12, 2024, noting a recommendation to continue physiotherapy sessions, to use the TENS machine she has at home, a minimum of 15-20 sessions of acupuncture, and hydrotherapy on a weekly basis for at least 6 months. Dr. Prutis opined that the applicant remained disabled.
45I give Dr. Prutis’ evidence little weight in this context because it does not engage with the applicant’s prior physiotherapy treatment, progress, or particulars as to what type of physiotherapy treatment the applicant should continue. Further, as the respondent notes, the applicant first produced this report at the submissions stage, contrary to the timelines set out in the CCRO, which required the exchange of evidence well in advance of submissions.
46The respondent submits that these plans are not reasonable and necessary. In support, the respondent submits that Dr. Khan opined the plan proposing $1,525.84 is not reasonable and necessary. Further, the respondent argues that there was little improvement in the applicant’s symptoms after 10 similar treatment plans had been approved or partially approved for similar treatment. The respondent submits that the applicant required surgery rather than more of the same treatment that was not expected to provide significant improvement. The respondent also questioned the proposed TENS treatment when a TENS machine was provided to the applicant for home use.
47Since the applicant has not addressed the line items in the proposed plans, except very generally, I find that she has not met her onus in establishing the proposed services in the plans are reasonable and necessary. Further, even if I was to accept the applicant’s submissions regarding her symptoms at the time, the evidence does not connect her symptoms, the goals of the plan, and the specific line items proposed in the plans.
48For the reasons above, on a balance of probabilities, I find that the applicant is not entitled to the plans in dispute.
xi. Is the applicant entitled to $412.22 ($3,155.59 less $2,743.27 approved) for psychological services, in a treatment plan proposed by Imperial Medical, partially denied December 28, 2023?
49I find that the applicant is not entitled to the disputed portion of this plan.
50This plan proposes services by a psychologist. The proposed services are 14 sessions of psychological counselling for 1 hour each, 2 counts of 1 hour each for testing, mental health, 3 counts of progress reports at 1 hour each, educational material, and completion of the OCF-18 form. The hourly rate proposed for the psychologist is $149.61 per hour. The goals are for the applicant to return to activities of normal living and pre-accident work activities.
51The respondent approved the psychologist’s rate at $149.61 per hour and partially approved the plan as follows:
i. $2,094.54 for 14 sessions of psychological counselling, for 1 hour each,
ii. $149.61 for 1 count of testing, mental health, for 1 hour,
iii. $448.83 for 3 counts of progress reports at 1 hour each, and
iv. $200.00 for completion of the OCF-18 form.
52In addressing the denied portions of the plan, the applicant relies on her submissions and does not refer me to evidence in support of her position that the denied portions of the plan are reasonable and necessary.
53Further, the approved services total $2,892.98, rather than the $2,743.27 identified by the parties at the case conference and reflected in the CCRO. For clarity, the denied amounts consist of $113.00 for educational materials and one additional hour of testing at $149.61, for a total denied sum of $262.61, consistent with the insurer’s denial letter dated December 28, 2023. The confusion may stem from the correspondence referencing a denied hourly rate of $149.61 for a psychotherapist or social worker and an approved rate of $91.43 per hour for these service providers.
54The parties addressed rates for providers other than a psychologist, however, the treatment plan identified a psychologist, Cody Eriksen, as the sole provider for all proposed services. The applicant addresses the hourly rate for a social worker and seeks approval for $100.00 per hour rather than $91.43 per hour. The applicant did not advance any arguments supporting the increased rate except for providing a general citation to Ring v Scottish and York Insurance Co., 2025 CanLII 42705 (ON LAT).
55The Tribunal’s prior decisions are not binding on me and there is no specific argument made for a higher rate than $91.43 per hour. Similarly, the applicant’s general argument that the applicant had not fully recovered does not establish that each of the denied portions of the plan are reasonable and necessary. Therefore, the applicant has not met her onus.
56For the reasons above, on a balance of probabilities, I find that the applicant is not entitled to the disputed portion of this plan.
xii. Is the applicant entitled to $1,284.92 ($2,856.37 less $1,571.45 approved for psychological services, in a treatment plan proposed by Imperial Medical, partially denied June 5, 2024?
57I find that the applicant is not entitled to the disputed portion of this plan.
58This plan proposes services by a psychologist that are identical to the plan proposing psychological services reviewed above, except that this plan proposes 12 sessions of psychological counselling rather than 14 sessions. The goals are for the applicant to return to activities of normal living and pre-accident work activities.
59The respondent approved the psychologist’s rate at $149.61 per hour and partially approved the plan as follows:
i. $1,097.16 for 12 sessions of psychological counselling, for 1 hour each,
ii. $448.83 for 3 counts of progress reports at 1 hour each, and
iii. $200.00 for completion of the OCF-18 form.
60The parties addressed rates for psychotherapists and social workers that ultimately provided the services, but the plan only lists one proposed provider, psychologist, Cody Eriksen.
61The denied amounts consist of $113.00 for educational materials, two hours of testing at $149.61 per hour, and a general denial of an hourly rate of $149.61 for psychotherapists. For the reasons set out above addressing the previous plan, which apply equally to the disputed portions of this plan, I find that the applicant has not met her onus to establish each of the denied parts of the plan are reasonable and necessary.
62For the reasons above, on a balance of probabilities, I find that the applicant is not entitled to the disputed portion of this plan.
xiii. Is the applicant entitled to $6,260.00 ($8,361.00 less $2,101.00 approved) for optometric services, proposed by Erin Haney Optometry in a treatment plan, partially denied October 16, 2024?
63I find that the applicant is not entitled to the disputed portion of this plan.
64Dr. Talia Jacob, optometrist, proposed the following services, and the respondent partially approved the plan as indicated below:
i. $880.00 for testing by optometrist, 8 counts at $110.00 each (Denied)
ii. $5,280.00 for sight and other senses training by other provider, 48 counts at $110.00 each (Denied)
iii. $120.00 completion of OCF-18 (Approved)
iv. $100.00 vision therapy toolkit (Denied)
v. $707.00 neurolens single vision (Approved)
vi. $1,274.00 neurolens single vision sunglasses (Approved)
65The goals are to assess and diagnose visual dysfunction.
66The applicant argues that the denied portions of the plan are reasonable and necessary based on the recommendations of Dr. Talia Jacob, as a result of a neuro-optometric assessment conducted March 25, 2024. The applicant argues that the plan should be approved due to her ongoing functional limitations. She submits that the respondent’s position is inconsistent, because it funded the glasses which means that it has accepted visual dysfunction needs to be addressed.
67The respondent argues that the denied portions of the plan are not reasonable and necessary and notes the sequence of events, which I find helpful in understanding this dispute. The respondent submits that it obtained a s. 44 neurological assessment by Dr. Michael Angel, neurologist, dated March 29, 2023 and the applicant did not report vision issues at that time. Then, Dr. Jacob prepared the plan on July 7, 2023 as reviewed above. The CNRs of Dr. Matthew Burke, cognitive neurologist, dated November 29, 2023 state that the applicant’s only main ongoing concern was photosensitivity, and he recommended consideration of blue light blocking glasses and potential for Gabapentin.
68A preponderance of the evidence does not indicate that the denied portions of this plan are both reasonable and necessary.
69In reaching this conclusion, I find that Dr. Jacob has not continued to recommend the disputed portion of the plan. Dr. Jacob’s neuro-optometric assessment report dated March 25, 2024 was prepared and is relied upon by the applicant. However, while this report contains detailed findings and recommendations, Dr. Jacob did not recommend any of the services denied in the subject plan and instead recommended neurolens which were already approved, physiotherapy, which is not proposed in this plan, and a reassessment post adaptation to the neurolens to consider a need for visual training or to continue physiotherapy. The applicant did not lead a post-adaptation opinion in support of the denied services as contemplated by Dr. Jacob.
70For the reasons above, on a balance of probabilities, I find that the applicant is not entitled to the disputed portion of this plan.
xiv. Attendant care benefits in the amount of $10,397.69/month denied January 9, 2023?
71I find that there is no basis to make an Order for attendant care benefits for the period September-October 2022.
72Section 19 of the Schedule states that an insurer shall pay for all reasonable and necessary expenses incurred by or on behalf of an insured person as a result of an accident for attendant care services (“ACBs”) provided by an aide or attendant. Section 42(1) of the Schedule provides that an application for ACBs must be in the form of, and contain the information required to be provided in, the version of the document entitled Assessment of Attendant Care Needs (“Form-1”).
73The applicant’s submissions indicate that the ACBs in dispute relate to the months of September and October 2022. However, the applicant did not identify any expenses incurred for this period that remain in dispute, the respondent’s correspondence confirms she remained eligible for ACBs up to the maximum policy limit through this period.
74The respondent submits that it approved the Form 1 completed by the occupational therapist on October 5, 2022, in the amount of $10,446.58 per month, subject to the applicant’s policy limit of $6,000 per month. The respondent further submits that it has paid the expenses incurred in accordance with that approval.
75While a second Form-1 exists, assessing ACBs at $10,397.69 per month, I find that it does not relate to the September–October 2022 period identified by the applicant as being in dispute. It is dated November 18, 2022, and was submitted on December 30, 2022. Although the second Form-1 was denied on January 9, 2023, the respondent simultaneously requested a s. 44 assessment to address its reasonableness, necessity, and the question of causation. The respondent’s January 9, 2023 notice also confirms that the applicant remained eligible for ACBs in accordance with the first Form-1 pending the outcome of the s. 44 assessment.
76As the applicant has not established the amount in dispute, or the basis for a finding of entitlement, I find, on a balance of probabilities, that there is no basis to make an Order for attendant care benefits for the period September-October 2022.
xv. Is the respondent (insurer) entitled to a repayment of $5,009.50 relating to its payment of income replacement benefits for the period of September 3, 2022 to March 24, 2023?
77On January 10, 2024, the respondent requested the outstanding balance of $5,009.50 for repayment of an IRB and repeated this request on July 17, 2024. The parties confirm in submissions that they have agreed to extend the time for repayment to September 30, 2025. The respondent requests an order confirming its entitlement to repayment, currently at $5,009.50, plus interest at the bank rate (4.75%) pursuant to s. 52 of the Schedule. The applicant does not object. However, since there is no dispute before me on this application, an order is not warranted. If a dispute between the parties emerges, it is incumbent on them to initiate an application at this Tribunal seeking resolution.
Interest
78The applicant is entitled to interest because it applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule.
ORDER
79For the reasons above, I make the following orders:
i. The applicant is entitled to 16 instances of travel costs for the massage therapist at $58.19 each, for a total cost of $931.04. The applicant is not entitled to the rest of this partially approved plan for physiotherapy services.
ii. The applicant is not entitled to the remainder of the disputed amounts for the treatment plans in dispute.
iii. There is no basis to make an Order for attendant care benefits for the period September-October 2022.
iv. The applicant is entitled to interest pursuant to s. 51 of the Schedule.
Released: May 28, 2026
Amar Mohammed
Adjudicator