The claimant sought entitlement to a treatment plan for physiotherapy. The insurer argued that it was not liable to pay the disputed treatment plan because it was not signed by the claimant or a health care professional as required by section 38(3). The insurer had not raised the issue of noncompliance with section 38(3) in its two Explanation of Benefits issued to the claimant regarding the disputed treatment plan. Adjudicator Lake found that if the insurer was not consenting to an unsigned copy of the treatment plan being received through HCAI and wanted to view the executed hardcopy on file at the clinic, it was incumbent upon the insurer to request a copy upon receipt of the electronic version. Further, Adjudicator Lake wrote that the insurer’s failure to only raise the issue at this late stage of the proceeding was inappropriate. She concluded there was no breach of section 38(3). The claimant argued that the insurer failed to comply with its obligations under section 38(8), as it provided no medical reasons for its denial of the disputed treatment plan. The insurer provided two OCF-9s that simply indicated the treatment plan was not reasonable and necessary. Adjudicator Lake determined that these reasons did not discharge the insurer’s obligations under section 38(8) as neither denial provided any details regarding the claimant’s condition that formed the basis of the insurer’s decision. The treatment plan was payable starting on the 11th business day after the insurer received the treatment plan.
