Category: LAT Rules

The claimant disputed entitled to two treatment plans for physiotherapy and chiropractic services. The insurer disputed the claimant’s entitlement based upon IE reports, and argued that new evidence was submitted in the claimant’s reply submissions were prejudicial. The insurer, by way of motion, requested that the new evidence was improperly submitted and requested it be struck from the hearing record. Adjudicator Grant partially agreed with the insurer regarding the striking of evidence. Adjudicator Grant noted that the right of reply was limited, and reply arguments were not the place to make new arguments or submit new evidence. The paragraphs containing new evidence or arguments were struck, and the paragraphs containing new medical claims (i.e., chronic pain) were struck as well as they were not supported by any previous evidence or arguments. The claimant argued that he was unable to include the new arguments in his original submissions due to COVID 19. Adjudicator Grant did not accept this argument, noting that the claimant could have communicated his inability to meet the submission deadline to the parties to ensure action was taken, and noted that the insurer was prejudiced by the late filing and new evidence as it was unable to mount a defence to the same or reply in kind. Adjudicator Grant determined that the disputed treatment plan for physiotherapy services was reasonable and necessary as both the claimant’s expert report and the IE assessor had reached similar conclusions regarding his physical status. The treatment plan for chiropractic services was not reasonable or necessary as it recommended an exercise bike and home exercises, which did not require the direct supervision of a chiropractor.

The claimant disputed entitled to 7 treatment plans for chiropractic treatment. The insurer argued that the claimant had filed his submissions two and half months late and requested that the submissions be excluded in their entirety, and sought costs. Adjudicator Grant noted that excluding the claimant’s submissions in their entirety would be severely prejudicial to the claimant and would lead to an unfair result. Adjudicator Grant further noted that although the submissions were submitted well beyond the deadline, the insurer was able to submit a response which appeared to address all of the issue in dispute, and that any prejudice suffered by the insurer would be minimal. Adjudicator Grant ruled that the disputed treatment plans for further chiropractic treatments were not reasonable or necessary. He noted that nowhere in the claimant’s submissions did his treating doctors recommend further chiropractic treatments. Adjudicator Grant awarded the insurer $300 in costs for the claimant’s late filing of submissions, reasoning that the award would deter and prevent such behaviour in the future.

The claimant sought entitlement to one treatment plan for chiropractic services. Adjudicator Cavdar concluded that the claimant had not adduced sufficient evidence to demonstrate that the proposed treatment plan was both reasonable and necessary. The decision was based on the fact that the treatment plans did not shed light on how the proposed chiropractic services would provide relief to the claimant based on the symptoms she was suffering at the time. The insurer also raised the procedural issue that the claimant’s written submissions should be struck in their entirety as they were submitted late and in breach of the Case Conference Order. The insurer further noted that the claimant submitted certain documentary evidence upon which it sought to rely more than one month after the deadline. The insurer sought an order that the claimant’s submissions be struck in their entirety or the records submitted late be struck, or if allowed to rely on the records submitted, the insurer be permitted a further right to respond. Adjudicator Cavdar found that it would not be procedurally fair to the claimant to strike the day-late submissions. Further, Adjudicator Cavdar wrote that it was not unduly prejudice to the insurer because the prejudice of striking the claimant’s day-late submissions outweighed any prejudice the insurer would be subjected to. Adjudicator Cavdar held that it would also be procedurally unfair to strike the evidence adduced by the claimant even though it was a month late and in violation of the Order. This was because the claimant provided a clear avenue to the insurer to garner sufficient additional time to review said evidence and submit its responding arguments at a date that was mutually agreeable. The claimant consented to pushing back the hearing date and the date of the insurer’s submissions, however, the insurer declined this offer and did not provide any explanation.