The claimant sought entitlement to a psychological assessment and a chronic pain assessment, plus a special award. As a preliminary matter, the parties’ submissions refer to a disagreement over whether the psychological assessment was withdrawn with prejudice by the claimant at a previous case conference in an earlier Tribunal matter. Adjudicator Maleki-Yazdi found that the claimant could proceed with the dispute, as there was no final order from the Tribunal regarding the assessment. The claimant argued that the insurer’s denial did not comply with section 38(8), as the denial was not made within 10 business days. The insurer argued that the treatment plan was submitted to Aviva Insurance Company of Canada, a separate legal entity, and the documents were not received by the insurer nor did it have access. Furthermore, the insurer submitted that the claimant did not comply with section 38(2) because the claimant incurred the cost of the treatment plan less than 10 days after the submission. Adjudicator Maleki-Yazdi held that the evidence demonstrated that the assessment was incurred prior to the submission to the insurer and none of the exceptions listed in section 38(2) applied to the case. With respect to chronic pain assessment, Adjudicator Maleki-Yazdi held that there was evidence that, as a result of the accident, the claimant experienced an exacerbation of the constant and/or severe pain that she experienced prior to the accident. Considering how frequently the claimant visited with her family physician, the fact that there were no further assessments of either Chronic Pain Syndrome or chronic neck/back sprain during the months prior to the accident demonstrated that she was not experiencing constant and/or severe pain leading up to the date of loss. There was also evidence that the claimant experienced some functional limitations as a result of the physical pain. The chronic pain assessment was there found to be reasonable and necessary. The special award claim was dismissed.
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