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Applicant v. TD Insurance (17-003496)

  • February 5, 2018

The claimant sought entitlement to six assessments to address his potential catastrophic impairment. Each assessment was in excess of $2,000. The insurer denied the assessments on the basis that the claimant had failed to prove causation (i.e. the accident was minor, and the claimant suffered psychological difficulties before the accident). Adjudicator Sewrattan granted the claimant’s request for all six assessments, but limited the total payable to $2,000 per assessment, $200 for the form fee, and HST. The adjudicator did not decide whether section 25 automatically entitled the claimant to the assessments, but held that even on a “reasonable and necessary” standard, it was appropriate for the claimant’s psychiatric impairments to be tested and to determine whether they were accident related. He also noted that the insurer has a total of 13 IE assessments, while the claimant had no assessment funded, and that the insurer’s catastrophic IE assessors did not offer opinions on the psychiatric impairment as part of a WPI measurement.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, CAT Assessments
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