The claimant disputed entitlement to three treatment plans for physiotherapy and chiropractic services, and a special award. Both parties raised preliminary issues at the hearing: the claimant alleged that the insurer failed to give appropriate notice under section 38, while the insurer alleged that the claimant failed to comply with the Tribunal’s rules of disclosure when he introduced both an affidavit from himself and a written statement from his treating physiotherapist in his hearing submissions without prior notice. Vice-Chair White allowed the additional evidence submitted by the claimant, noting that the Order of Adjudicator John was “overly broad” and its only direction regarding disclosure and deadlines noted that no new evidence could be submitted after the date of the hearing. As the evidence was provided on the date of the hearing, it was allowed. Vice-Chair White ruled that the insurer did not comply with section 38 in relation to two of the disputed treatment plans, as the denial letters were insufficient in their language and medical and other reasons for the denial. The services incurred between the 11th business day and the date of the final (compliant) denial were found payable. The third disputed treatment plan was found not payable based on the chiropractic IE. Although a special award was requested in the Case Conference Order, the claimant did not raise the issue within the pleadings submitted, and as such, it was not considered.
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