G.L. v. TTC Insurance Company Limited (18-005322)

The claimant sought entitlement to five treatment plans. In addition to arguing that they treatment was reasonable and necessary, the claimant also argued that the insurer’s denials of three medical benefits did not comply with section 38(8) of the SABS. Adjudicator Grant found that the proposed treatment was not reasonable and necessary due to the lack of medical evidence. The claimant could not show that treatment was assisting him in any way or improving his functionality. Adjudicator Grant awarded the expenses related to two treatment plans which were not denied within the 10 day period required by section 38(8).