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Levey v. Aviva Insurance Company (19-006014)

  • July 29, 2020

The claimant applied to the LAT seeking entitlement to psychological services and the balance of a partially approved OCF-18 for driving lessons. Adjudicator Parish found that the claimant was not entitled to the disputed benefits. Adjudicator Parish noted that the OCF-18 for psychological services was completed by a psychologist, but the claimant previously received and only wanted therapy from a particular psychotherapist, who was not listed as the service provider on the OCF-18. The rates proposed on the OCF-18 were the rates for a psychologist, as per the Professional Services Guidelines. Adjudicator Parish did not accept that a psychotherapist should be paid the same rate as a psychologist. Adjudicator Parish also found that the psychological services were not payable as the claimant had failed to comply with the insurer’s section 33 requests. The balance of the partially approved OCF-18 for driving lessons was not payable as the hourly rates approved by the insurer were reasonable.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Section 33
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