The claimant sought entitlement to various denied catastrophic impairment assessments, and the cost of x-rays. The insurer had approved some of the catastrophic impairment assessments, but denied others. At the time of the hearing, the claimant had been declared catastrophically impaired. Adjudicator Sewrattan awarded the cost of the physiatry assessment, even though an orthopaedic assessment had been approved. He reasoned that it was an appropriate assessments as part of an overall determination. The adjudicator denied the cost of a File Review and a Whole Person Impairment Analysis, reasoning that both assessments were duplicative of services that had been approved (the file review as part of the $2,000 assessment fee, and the WPI analysis as part of an approved “Overall Assessment”). The cost of the x-ray was denied because it was reasonably available through OHIP.
Menu