Being injured in a motor vehicle collision is already a challenge. Those who seek support from naturopaths, medical cannabis, or other ‘novel’ treatments to aid in their recovery may feel added stress as to whether the treatment they seek will be approved, and paid for, within the scheme of the Statutory Accident Benefits Schedule.
The Licence Appeal Tribunal (“the Tribunal”) is an independent, quasi-judicial agency that adjudicates as to whether a course of treatment falls within the statutory accident benefits that an insurer must pay. Generally, the Tribunal is open to the concept of novel treatments. The Tribunal’s decisions typically recognize that injured individuals know their bodies best and ought to be able to select the treatment most appropriate for them. However, the Tribunal still requires applicants to prove that a treatment is reasonable and necessary before deciding that an insurer should pay for the benefits.
There are a number of points that the Tribunal considers when analyzing whether a treatment plan is reasonable and necessary:
- Addressing the issues: Generally, it is useful to provide information on how the proposed novel treatment addresses the applicant’s issues.
- Other treatments: Another useful piece of information is whether the applicant has already unsuccessfully attempted more traditional forms of treatment.
- Improvements: If a treatment has already demonstrated itself helpful for the applicant, the applicant may want to share this information as well. The applicant may want to explain how the treatment has improved their functionality (e.g. improving sleep, discontinuing the use of medications with negative side effects, improving functioning levels, improving mood, reducing anxiety, etc.).
- Support of other professionals: A treatment plan will likely carry more weight if multiple professionals support it. For instance, having a family doctor corroborating the benefit of a novel treatment assists the Tribunal in understanding the importance of that treatment.
It is possible that an individual injured in a motor vehicle collision will be able to pursue the course of treatment that they believe to be the most appropriate for them.