The claimant disputed entitlement to additional funding for catastrophic impairment assessments. The insurer had approved $12,000 for an executive summary, psychological assessment, neurocognitive assessment, orthopaedic assessment, and occupational therapy assessments. The claimant sought a further $11,533.24. Adjudicator Boyce concluded that the denied assessments were not reasonable and necessary. The denied items were psychometric testing, scoring, and interpretation; neurocognitive testing, scoring and interpretation; a musculoskeletal examination; an occupational therapy situational evaluation; an occupational therapy collateral interview; and a WHODAS 2.0 assessment. Adjudicator Boyce found that the claimant’s proposed assessments were needless bifurcations or duplications of assessments, which was done to garner additional funding. He noted that the insurer was able to complete its catastrophic impairment assessments with funding of $12,000 and the claimant failed to prove why his assessors could not also do so. The claimant’s arguments that he suffered unique complex injuries warranting additional funding was rejected. The claimant’s argument that his assessors required twice as long because of his poor English skills was also rejected. Adjudicator Boyce did award a total of $400, being the cost of completing the OCF-18 and the OCF-19.
Menu