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H.M. v. Intact Insurance Company (18-003979)

  • March 5, 2020

The claimant sought entitlement to a treatment plan for physiotherapy, and cost of examinations for a neurological assessment and a chronic pain assessment. Adjudicator Johal reviewed the medical records on file, which indicated numerous treating practitioners’ opinion that further physiotherapy would be beneficial, and concluded that the disputed treatment for ongoing physiotherapy was reasonable and necessary as the claimant did not have to prove his injuries were “substantive”, only that the need for the treatment was reasonable and necessary. Adjudicator Johal dismissed the claims for the denied examination for a neurology assessment as the treating neurologists on file did not recommend it in their records, and in fact, only recommended further physiotherapy. The chronic pain assessment was denied because while the treating practitioner diagnosed the claimant with chronic pain, there was no indication that a further assessment was required.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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