17-002734/AABS v Tradition Mutual Insurance Company

Jan 12, 2018

Adjudicator: Ian Maedel

Issues:

a) Entitlement to cost of examination for psychological assessment proposed by Dr. JoAnne Leavy.

b) Interest on overdue payments

Results:

The disputed treatment plan is reasonable and necessary and interest is due on amounts incurred to-date.

The Applicant argued procedural fairness in that the Respondent was able to perform a psychological assessment (in denying the treatment plan) and so they should be permitted to respond.  They relied on Certas v Consalves, 2011 ONSC 3986.  This was distinguishable however because Gonsalves was a matter of an Applicant serving reports shortly before a hearing and an insurer was not permitted time to respond, which are different facts than this case. This argument was rejected.

There was evidence in favour of an assessment found in the disability certificates, family doctors records including a prescription of anti-depressants.  The treatment plan by Dr. Leavey and telephone pre-assessment concluded that psychological treatment would be required and an assessment would be necessary to determine the extent of that treatment.

Based on the totality of the evidence, a psychological assessment was deemed necessary. The Applicant’s evidence was found to be more compelling due to consistent reporting of symptoms indicative of a psychological injury as well as the prescription of anti-depressants more than once and by more than one health practitioner also supported further investigation and possibly treatment.

The adjudicator took no issue with the telephone method of the pre-screening interview. The adjudicator also held that family doctors are qualified to render a diagnosis of psychological injury as they are the first point of contact with a patient and can detect and treat mental health disorders and make referrals to mental health professionals.

Also entitled to interest as per s. 51 of the Schedule.

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