N.S. v TD General Insurance Company (19-002494)

The claimant applied to the LAT disputing entitlement to various treatment plans and interest. The claim was outside the MIG, so Adjudicator Norris had to determine whether the treatment plans were reasonable and necessary. Adjudicator Norris found that the physical therapy and OT treatment plans were reasonable and necessary. Adjudicator Norris noted that with his approval of benefits, the insurer would have approved treatment plans over the policy limits ($50,000). Adjudicator Norris found that the insurer and the claimant had to decide which benefits the claimant would incur within the policy limits and his role as Adjudicator was only to decide on the reasonableness of the treatment plans and not how they would be paid out.