The claimant disputed his entitlement to various treatment plans. The insurer argued that the claimant and his treatment provider failed to comply with section 38(2), 49.1, and 64 of the SABS, and that none of the treatment plans were payable. Adjudicator Grant held that each of the noted provisions were mandatory and the claimant’s failure to comply led to the treatment plans not being payable. Section 38(2) required the claimant to submit the treatment plans prior to receiving the proposed treatment; he did not do so. Section 49.1 required an unlicensed provider to deliver a printed invoice to the claimant, who was required to submit the invoice to the insurer; that did not occur. Section 64 required registration with HCAI by the treatment provider and submission of OCF-21s through HCAI; the treatment provided did not follow these requirements.
