The claimant sought entitlement to the balance of a partially approved psychological assessment. Adjudicator Punyarthi held that the claimant was not entitled to the remaining balance as there was no evidence substantiating the claimant’s entitlement. The adjudicator specifically noted that the treatment plan at issue was vague and unparticularized, and there was no justification as to why the time as claimed was necessary. The insurer relied on the opinion of its psychological assessor as to the number of hours that should be spent on the tasks of the assessment, and applied the hourly rate for a psychological that was provided in the Professional Services Guideline. The adjudicator refused to rely on an email from the claimant’s assessor containing an estimated breakdown of time spent as it was not disclosed to the insurer prior to submissions at the hearing.
Menu