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B.H.X. v. Aviva General Insurance (19-002556)

  • July 31, 2020

The claimant sought entitlement to NEBs, a psychological assessment, and the cost of a plastic surgery consult. Adjudicator Norris dismissed the claims for NEBs and plastic surgery consult, but awarded the psychological assessment. The claimant failed to provide evidence supporting NEB entitlement, and his self-reporting suggested he was in fact more active after the accident, and he maintained independence with personal care, meal preparation, and household chores. The plastic surgery consult was incurred prior to the submission of the treatment plan, so it was not payable. The psychological assessment was found reasonable and necessary, but not payable because it was not incurred.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Non-Earner Benefits
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