The insurer initially accepted that the claimant sustained a catastrophic impairment, but reversed its decision upon receipt of ODSP records detailing similar pre-accident impairments. The claimant argued that the treatment plans submitted during the period while she had access to the catastrophic impairment limits ought to be payable. The insurer argued that because the claimant did not truly suffer a catastrophic impairment, she was not entitled to any medical benefits in excess of the standard limits. Vice Chair Lester held that the claimant was entitled to seek medical benefits in excess of the standard limits for the time period the insurer had advised that she was catastrophically impaired. Vice Chair Lester considered each claimed medical benefit under the reasonable and necessary standard, and awarded the treatment plans for psychological treatment (aside from transportation costs). Further physical therapy was mostly denied as there was no evidence to suggest that the claimant received any benefit from the treatment. No submissions were made regarding occupational therapy or an attendant care assessment. Those claims were also denied.
