S.K. v. Aviva Insurance Company of Canada (18-011027)

The claimant sought entitlement to four treatment plans – two for psychological services (which were partially approved), and two for physiotherapy services. Adjudicator Boyce awarded one treatment plan for physiotherapy, but denied the remainder of the claims. Regarding the partial psychological treatment plan amounts, the adjudicator held that the claimant failed to prove that the denied amounts were reasonable and necessary, and wrote that just because a maximum was available under the SABS did not mean that the maximum was always payable. In terms of the physiotherapy treatment plans, the adjudicator held that the earlier treatment plan may have provided benefit, while the latter would not.