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N.K. v. Intact Insurance Company (19-003405)

  • April 17, 2020

The claimant sought entitlement to the costs of examinations in two treatment plans that were performed as part of catastrophic impairment assessments. Adjudicator Norris found that although a psychiatric assessment was performed instead of an approved psychological assessment, the psychiatric assessment was reasonable and necessary in light of the claimant’s post-concussion mental condition. The claimant was only entitled to $2,000 for the cost of the psychiatric assessment, however, as the fact that the assessment formed the basis of the catastrophic impairment determination did not entitle him to funding above the $2,000 limit on assessment costs per section 25(5)(a) of the SABS. Adjudicator Norris also found the claimant entitled to the costs of two occupational therapy assessments. Interest was found payable on both disputed treatment plans.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, CAT Assessments
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