The claimant applied to the LAT seeking entitlement to a treatment plan for physiotherapy and sought a special award. Adjudicator Boyce found the claimant was entitled to the treatment plan, plus interest, and given a special award in the amount of $250.00. Adjudicator Boyce found that the insurer’s denial letter did not comply with section 38(8), as the insurer did not provide adequate medical reasons for its denial. In particular, the insurer noted in its letter that there was “”no compelling evidence”” to support treatment, however, the insurer had medical documentation in its possession where medical professionals recommended the precise treatment in dispute. Adjudicator Boyce found that per section 38(11), the treatment plan was payable. Adjudicator Boyce also found that the insurer unreasonably withheld the payments as it did not provide a proper denial. Adjudicator Boyce awarded a special award in the amount of $250 representing approximately 10 percent the cost of the disputed treatment plan.
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