Applicant is in an accident but treatments not reasonable and necessary - Applicant v Aviva LAT 16-001928

February 12, 2018, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

Applicant v Aviva LAT 16-001928

Decision Date: November 23, 2017
Heard Before: Adjudicator Sandeep Johal

WAS IT AN ACCIDENT and ENTITLEMENT TO BENEFITS: Applicant is in accident; applicant does not provide evidence that treatment plans are reasonable or necessary

The applicant was injured in a car accident on May 28, 2014 and sought benefits pursuant SABs. When Aviva denied the claim the applicant applied to the LAT.

Issues:

1. Did the applicant sustain an impairment within the meaning of the Schedule as a result of the accident?
2. Is the applicant entitled to receive a medical benefit in the amount of $4,447.56 for physiotherapy services in a treatment plan dated May 26, 2015?

Result:

1. The applicant did sustain an impairment as a result of the accident
2. The applicant has not established on a balance of probabilities that the treatment plan in dispute is reasonable and necessary.

The applicant has the onus to prove on a balance of probabilities that the treatment plan being requested is reasonable and necessary. 

The Arbitrator reviewed the applicant’s medical notes and treatment plans and noted that the applicant’s own family doctor noted her back pain resolved on June 9, 2014.  Her MRI was with respect to knee pain that took place, more than a year post accident and there is no recommendation with respect to treatment.  The treatment plan in dispute for this hearing is not clear on what is being done to treat her “right chondromalacia patellae” or knee injuries.

The Arbitrator determined that Aviva’s IE report and clinical findings were more persuasive than the evidence the applicant is relying on. On that basis the treatment plan is not reasonable and necessary and the applicant’s claim for physiotherapy services in the amount of $4,447.56 is denied.

About Deutschmann Law

Deutschmann Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.deutschmannlaw.com or call us at 1-519-742-7774.

It is important that you review your accident benefit file with one of our experienced personal injury / car accident lawyers to ensure that you obtain access to all your benefits which include, but are limited to, things like physiotherapy, income replacement benefits, vocational retraining and home modifications.