The claimant sought the cost of an orthopaedic assessment. Adjudicator Goela held that the respondent’s denial letter did not provide a medical reason why an orthopedic examination was not reasonable or necessary pursuant to section 38(8) of the SABS. The denial letter stated that pursuant to the physiatrist report, further physical intervention would not affect the recovery of the claimant’s shoulder, and that cortisone injections could be more beneficial. The denial letter did not elaborate any further. Adjudicator Goela also concluded that even if she did not find that the respondent failed to provide a medical reason for denying the benefit, the orthopedic assessment was reasonable and necessary. Adjudicator Goela further held that the cost of completing the OCF-18 in the amount of $200.00 and HST were not subject to the $2,000.00 limit.
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