• FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education
  • FAIR – supporting auto accident victims through advocacy and education

IME

16-002861 v Aviva Insurance Company, 2017 CanLII 62160 (ON LAT)

[40.]     The applicant submitted that the respondent unreasonably withheld or delayed payment regarding the medical benefits for physiotherapy services and the cost of psychiatric and orthopaedic assessments.  I agree that the payment for physiotherapy services and the psychiatric and orthopaedic assessments were unreasonably withheld for the reasons that follow.
 
[41.]     Regarding the physiotherapy services, the respondent does not dispute that the applicant has chronic pain syndrome, but whether the treatment will lead to the applicant’s recovery. Drs. West and Gerber indicated that the applicant will not likely recover from the pain despite appropriate treatment.  I am of the view that the goal for treatment for this applicant should be pain relief and reduction given his chronic pain diagnosis. As such, I do not agree with the respondent’s rationale that given the applicant is not able to recover from his injuries that further physiotherapy treatment is not reasonable and necessary.  
 
[42.]     Regarding the assessments, given that Drs. West and Gerber’s assessments were dated and the persistent nature of the applicant’s chronic pain, I find that it was reasonable for the applicant to request to undergo new assessments in order to determine if the assessors could recommend other treatments at this stage of his chronic pain.  I am not persuaded by the respondent’s position regarding the denial of the assessments given the nature of the applicant’s chronic pain and the timing of his prior assessments.
 
[43.]     Regarding the length of the respondent’s delay, the respondent delayed payment for 1-3 years depending on the treatment plan.  The delay in payment of the treatment plans delayed the applicant’s ability to effectively manage his chronic condition.  According to the applicant, he had to incur the cost of the physiotherapy services, which has impacted him financially.

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