The claimant sought payment of treatment plans seeking chiropractic treatment and a chronic pain program. The claimant argued that some of the denials were non-compliant with section 38 of the SABS. The insurer argued that some of the treatment plans were denied more than two years after the denial and were time barred. Adjudicator Norris found one of the treatment plans to be barred by the limitation period as it was denied in compliance with section 38, and the claimant failed to provide reasons why section 7 of the LAT Act should extend the limitation period. A treatment plan for chiropractic therapy was denied without adequate medical reasons. It only stated that the treatment plan was identical to an earlier treatment plan which was denied by IE, but failed to set out those earlier reasons for denial. Another treatment plan for chiropractic treatment was denied but the correspondence did not indicate the MIG applied. Nevertheless, Adjudicator Norris concluded that the proposed treatment was not reasonable and necessary. Finally, a chronic pain program was denied two months after submission. The treatment plan was found not reasonable and necessary, but the insurer was required to pay for amounts incurred up to the date of denial.
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