The claimant sought attendant care and medical benefits for chiropractic treatment and a psychological assessment plus interest. The insurer had paid various medical and rehab benefits as well as ACBs. It denied the ACBs after the 104 week mark as the claimant was not deemed catastrophically impaired. The insurer also denied the chiropractic treatment and psychological assessment based on IEs that determined they were not reasonable or necessary. The claimant argued that the insurer was required to resume payment of ACBs because she had made a catastrophic impairment application. In regard to ongoing ACBs, Adjudicator Boyce found while an OCF-19 had been submitted and CAT assessments had been scheduled, there was no dispute between the parties that the claimant had not yet been found catastrophically impaired and as submitted by the insurer, that issue was not before the Tribunal at this time. Adjudicator Boyce also found the insurer’s denial notice of ACBs clearly indicated the insurer’s position and since there was no dispute the claimant was not yet deemed catastrophically impaired, the exception under section 20(3) of the SABS was not triggered. It, therefore, followed that the claimant was not entitled to ongoing ACBs for the period in dispute that fell outside the two year mark by section 20(2) of the SABS. With respect to the disputed chiropractic treatment, Adjudicator Boyce agreed with the IE opinions based on the medical evidence. Adjudicator Boyce found the claimant did not satisfy her burden to show why another psychological assessment was reasonable and necessary or why the assessment was not a duplication of assessments already conducted in the same year and to date.
