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J.S. v. Aviva Insurance Canada (18-008643)

  • January 13, 2020

The claimant sought entitlement to an orthopedic assessment, a chiropractic treatment plan, interest on the payment of overdue benefits, and a special award. Adjudicator Norris found that the disputed orthopaedic assessment plan was not reasonable and necessary; it was a duplication of services as the claimant was previously assessed by an orthopaedic fewer than two months prior to the submission of the disputed orthopaedic assessment plan. There were no new orthopedic injuries reported during the time leading up to the submission of the assessment plan. Adjudicator Norris also found that the disputed chiropractic treatment plan was not reasonable and necessary, noting that the treatment plan addressed injuries that were not accident-related and the claimant had already returned to work and was independent with self care at the time it was proposed.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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