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S.H.S.K v. Allstate Canada (18-003699)

  • September 16, 2019

The claimant applied to the Tribunal disputing his entitlement to four treatment plans and interest. Of the four disputed treatment plans, the claimant disputed his entitlement to an orthopaedic assessment and MRI. Adjudicator Kaur concluded that the claimant did not prove that the orthopaedic assessment and MRI were reasonable and necessary as he failed to show how or why he could not obtain the assessment and MRI through OHIP. The claimant also disputed his entitlement to physiotherapy, which Adjudicator Kaur found was not reasonable and necessary, as the claimant did not provide evidence of a treating practitioner recommending this type of modality for his accident-related injuries. Finally, the claimant disputed his entitlement to a chronic pain assessment. Adjudicator Kaur noted that the claimant failed to provide any clinical notes and records that illustrated a history of ongoing pain complaints and that therefore, the proposed chronic pain assessment was not reasonable or necessary.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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