The claimant sought entitlement to over $20,000 for multidisciplinary catastrophic impairment assessments. The insurer argued that the claimant had exhausted her medical benefits limits, that the proposed assessments were not reasonable and necessary, and that the assessment costs were in excess of the $2,000 limit. Adjudicator Grant held that the medical benefits limits did not apply to catastrophic impairment assessments, and that each assessment could cost up to $2,000. In order to be payable though, each proposed assessment had to be reasonable and necessary. He awarded the cost of the neurological, occupational therapy, psychiatry, and orthopaedic assessments. He rejected the claims for a file review and a medical document review, which should fall within the cost of each approved assessment.
Menu