17-000149/AABS v Wawanesa Mutual Insurance Company

Jan 16, 2018

Adjudicator: Aggrey Msosa


Entitlement to two treatment plans for orthopaedic assessments submitted by Dr. Khal Efala and Dr. West.


The Applicant is not entitled to the proposed treatment plans.

Neither party included a copy of the treatment plans in dispute. As a result, the adjudicator was not able to determine the objectives, goals of the proposed treatment in the plans. The only medical evidence that was submitted by the Applicant were two orthopedic medical assessment reports by Dr. Langer and Dr. West. In the absence of the treatment plans it was unclear whether the reports supported the proposed objectives/goals of the treatment plans. Without the treatment plans the adjudicator could not connect the evidentiary dots from the request to the outcome to determine if it was reasonable and necessary. Also absent was any evidence of an orthopedic injury as a result of the accident.

The Respondent provided an assessment report by Dr. Castiglione who diagnosed only soft tissue injuries and opined that an orthopedic assessment was unnecessary as the injuries were only soft tissue.

As a result, the Applicant was not found to have shown that the assessments were reasonable and necessary.