We are providing this update from a previous post on a question that prospective clients routinely ask pertaining to the number of treatments they are ‘allowed’ according to their insurer.
To put it simply the ’21 treatment’ limit is simply not the case.
The regulations provide that you are entitled to 21 treatments (which may include massage/acupuncture etc.,) recommended by either a physician, chiropractor or physiotherapist. These treatments must be paid for by your insurer to the treatment provider. After you have exhausted the first 21 treatments you are entitled to be reimbursed for further treatments that are deemed essential (by your treating physician/doctor). Here’s the relevant portion from the Section B part of your insurance policy (everyone’s policy is the same) :
[the insurer shall pay]…all reasonable expenses incurred within 2 years from the date of the accident as a result of those injuries… necessary medical, surgical, chiropractic, dental, hospital, psychological, physical therapy, occupational therapy, massage therapy, acupuncture, professional nursing and ambulance services and, in addition, for other services and supplies that are, in the opinion of the Insured person’s attending physician and in the opinion of the Insurer’s medical advisor, essential for the treatment or rehabilitation of the Injured person, to the limit 01 $50,000 per person.
(2) Notwithstanding provision (1),
(a) expenses payable in respect of chiropractic services provided under provision (1 )(b) are limited to $750 per person;
(b) expenses payable in respect of massage therapy services provided under provision (1)(b) are limited to $250;
(c) expenses payable in respect of acupuncture services provided under provision (1 )(b) are limited to $250.
Note that there is no effective limit on physiotherapy expenses (i.e. like the ones for chiropractic, massage and acupuncture). The way that your insurance company will likely try to get out of paying for the ongoing treatment (i.e. beyond the first 21 treatments) is to send you to their own ‘medical advisor’ in the expectation that the report will say ‘take two aspirin and you’ll be fine in the morning’.
Talk to a lawyer if you get into an argument with your insurer over the benefits that you are entitled to.