The claimants, two adult children whose mother was seriously injured in a motor vehicle accident, sought entitlement to one treatment plan each for social work assessments. The claimants failed to attend IEs. The claimants took the position that they were not required to attend the IEs because the treatment plans were automatically payable on the basis that RBC did not approve or deny the OCF-18s within 10 business days. Adjudicator Sewrattan concluded that the respondent was not required to pay for the assessments incurred by each of the claimants, as the claimants had incurred the expense prior to the expiry of the 10 day period. The expenses were thus incurred before the respondent could reasonably approve or deny the expense, and the claimants were precluded from applying to the LAT pursuant to section 55 of the SABS.
