P.V. v. Aviva Insurance Company (18-009130)

The claimant sought entitlement to nine assessments in relation to a catastrophic impairment determination. The insurer approved four (an orthopaedic assessment, an occupational therapy assessment, a psychiatry assessment, and a WPI rating); it denied five other assessments. Adjudicator Boyce accepted that each assessment had to be reasonable and necessary for the completion of the OCF-19 in order to be payable. He found only one further assessment – a functional review evaluation – to be reasonable and necessary. The remaining four assessments were largely duplicative and not essential for the completion of a catastrophic impairment determination.