Neither party submits disputed treatment plans to the LAT - AR and Wawanesa Mutual Insurance Company LAT 17-000149 2018 CanLII 2308

April 10, 2018, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

AR and Wawanesa Mutual Insurance Company LAT 17-000149 2018 CanLII 2308 Date: 2018-01-16

Date of Decision: January 16, 2018
Heard Before: Adjudicator Aggrey Msosa

COST OF ORTHOPAEDIC EXAM: Neither party submits disputed treatment plans to the LAT; adjudicator cannot assess them; rules on medical evidence provided

AR  was involved in a car accident on October 11, 2012, and sought benefits pursuant to the SABs. When Wawnesa denied two treatment and assessment plans for orthopedic assessments AR applied to the LAT for arbitration.

Issues

1. Is AR entitled to payment for the cost of an orthopaedic examination in the amount of $2,149.73 as set out in a treatment and assessment plan?
2. Is AR entitled to payment for the cost of an orthopaedic examination the amount of $2,200 as set out in a treatment and assessment plan dated?

Results

1. AR is not entitled to the proposed treatment plans.

The Schedule provides that an insurer shall pay reasonable fees for an examination or assessment. Neither party included a copy of the treatment plans in dispute. The parties were directed in the case conference report and order to include all evidence in support of their positions in accordance with the timetable as set out in the order.

In the absence of these treatment plans, the adjudicator was unable to determine the objectives and goals, nor the proposed treatment, if listed, of the treatment plans. On the basis of the medical evidence provided the Adjudicator found that the neither treatment plans are reasonable and necessary.

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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.