L.G. v. Unifund (18-008089)

The claimant sought entitlement to over $15,000 for multidisciplinary catastrophic impairment assessments. The insurer denied the assessments because the claimant had exhausted her medical benefits limits. Adjudicator Victor held that the cost of catastrophic impairment assessments did not fall within the medical benefits limits. She held that the claimant had to prove that each assessment was reasonable and necessary. Since it was possible that the claimant may have suffered a catastrophic impairment, it was reasonable for her to incur the proposed costs.