The claimant suffered a non-minor injury and sought entitlement to one treatment plan for physiotherapy. The insurer argued that the treatment was not reasonable and necessary. As a preliminary issue, the insurer argued that the claimant submitted her materials to the LAT four days late, and that the materials should be excluded. Adjudicator Hines allowed the materials to be considered, reasoning that no prejudice was suffered by the insurer, and the hearing was being held in writing. In terms of the treatment claim, Adjudicator Hines concluded that the treatment was not reasonable and necessary for multiple reasons: first, the claimant was relying on outdated medical assessment; second, one would expect injuries and symptoms to improve over time; third, a diagnosis of chronic pain does not automatically entitle an insured to unlimited treatment without proving an ongoing impairment; and fourth, the insurer’s IE assessment was more current and demonstrated the claimant’s improvement over the five years since the accident.
