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Amoaka v. Aviva Insurance Company of Canada (20-000377)

  • November 29, 2021

The claimant sought entitlement to an OCF-18 seeking funding for CAT assessments, submitted by an occupational therapist. The insurer denied the OCF-18 on the basis that since an occupational therapist could not complete an OCF-19, an occupational therapist could not propose CAT assessments. The claimant argued that section 45(2)(1) referred only to the submission of an OCF-19, and not to the submission of an OCF-18, and as such, non-physicians (including OTs) are entitled to complete Part 4 of an OCF-18 seeking funding for CAT assessments, so long as the non-physician(s) do not complete or submit the OCF-19 itself. Vice Chair Boyce agreed with the claimant, holding that so long as a physician opines on whether the claimant sustained a CAT impairment and completes the OCF-19, a non-physician’s role in completing an OCF-18 recommending CAT assessments is appropriate under the SABS.

Full decision here

TGP Analysis

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  • FILED UNDER CAT Assessments
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