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O.S. v. Certas Home and Auto Insurance Company (18-006633)

  • June 5, 2020

The claimant disputed entitlement to three treatment plans for chiropractic services, an orthopaedic assessment, and a neuropsychological assessment, as well as multi-disciplinary CAT assessments. Adjudicator Pinto ruled that all disputed plans were not reasonable or necessary based upon the evidence provided. In her decision, she noted that the disputed treatment plans did not provide medical reasons for the necessity of the services provided in relation to the subject accident. A review of the claimant’s medical records did not show that the claimant’s treating practitioner’s, specifically the family doctor, believed it was reasonably possible that the claimant was catastrophically impaired. All claims were dismissed.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, CAT Assessments
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