The claimant sought to be removed from the MIG and entitlement to medical benefits. Adjudicator Mazerolle concluded that the claimant established that he suffered from an accident-related psychological impairment. As such, he was no longer held to the funding and treatment limits of the MIG and s. 18(1) of the Schedule. Adjudicator Mazerolle found that the totality of the records established that psychological symptomology had affected some aspects of the claimant’s daily life. The medical benefits at issue were a psychological assessment, psychological services, and physical therapy. While Adjudicator Mazerolle accepted that the claimant suffered from a psychological impairment, he did not find that the proposed psychological services were payable, due to s. 47(2) of the Schedule. Once the insurer introduced the possibility of the claimant accessing publicly funded therapy through OHIP, the onus shifted to the claimant to rebut this proposition. What is more, the insurer supported this assertion by filing an information sheet from the Centre for Addiction and Mental Health (CAMH) that listed a number of publicly funded clinics and service providers—evidence that this treatment was (in the words of s. 47(2)) “reasonably available to the insured person”. However, Adjudicator Mazerolle could not draw the same conclusion about s. 47(2) for the psychological assessment, as there is no indication whether a similar service was “reasonably available” to be paid through OHIP. Therefore, Adjudicator Mazerolle found the psychological assessment to be payable by the insurer. Finally, Adjudicator Mazerolle was not satisfied that the physical therapy services were necessary for the claimant’s recovery as there was evidence that physical therapy was no longer assisting the claimant with his accident-related impairments.
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