U.P. v. Aviva General Insurance Company (19-007557)

The claimant sought entitlement to two treatment plans, a chronic pain assessment and physiotherapy treatment. Adjudicator Kaur found that the claimant was entitled to both benefits. The evidence supported that the claimant continued to suffer from ongoing pain and impairment. With respect to the chronic pain assessment, the Adjudicator preferred the claimant’s evidence and held that the assessment was reasonable and necessary, as there was sufficient evidence of continued pain to warrant further investigation. With respect to the physiotherapy treatment, the Adjudicator found that the claimant had not yet reached maximal medical recovery and would benefit from the recommended facility-based treatment. As such, the treatment plan was deemed reasonable and necessary.