Motorcycle rider hit by car - treatments reasonable and necessary - KWD and Progressive CANLII 39450 ON LAT 17-003705

June 14, 2018, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

K.W.D. and Progressive American 2018 CanLII 39450 (ON LAT 17-003705)

Date of Decision: March 7, 2018
Heard Before: Adjudicator Anita Goela

MEDICAL BENEFITS:  are treatments reasonable and necessary; applicant hit by car while riding motorcycle; adjudicator reviews evidence and determines treatment reasonable and necessary

KWD was injured in a motor vehicle accident on October 10, 2015 and sought benefits pursuant to the SABs which Progressive denied on the basis that the benefits were not reasonable and necessary. KWD applied to the LAT for dispute resolution.

Issues:

1. Is KWD entitled to a medical benefit for physiotherapy services in a treatment plan dated January 31, 2017 in the amount of $3,003.85?
2. Is KWD entitled to interest for the overdue payment of benefits?

RESULT

1. KWD is entitled to the treatment plan in dispute. Because the benefit is owing, interest is payable for any incurred services.

ANALYSIS

The Adjudicator reviewed the Schedule and noted that an insurer is only liable to pay for medical expenses that are reasonable and necessary as a result of the accident. KWD bears the onus of proving on a balance of probabilities that the treatment plan is reasonable and necessary.

KWD was a passenger on a motorcycle driven by her husband when it was rear-ended by a car. She was thrown off the motorcycle and her head broke the car’s windshield. Her helmet came off due to the impact of the accident. Her injuries include concussion, post-concussion syndrome, headache, vision problems, neck, back, leg and hip pain. KWD also experiences psychological issues, including those related to memory, since the accident.

The Adjudicator found the medical evidence produced by KWD and Progressive consistent. KWD’s injuries appear to be improving and KWD continues to make progress. However, the parties disagreed whether ongoing physiotherapy treatment was reasonable and necessary.

The goals stated in the disputed treatment plan are pain reduction, increase in strength, increased range of motion, improved activity tolerance, improved vestibular and oculomotor function. KWD submits that physiotherapy treatment will continue to address her post-concussion syndrome, low back and neck pain. The Adjudicator found that the goals are reasonable and necessary given the injuries sustained by KWD from the accident.

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.