The claimant disputed entitlement to a partially approved OCF-18 for psychological services in the amount of $3,591.87. The insurer paid $2,444.15 of the OCF-18 based upon the Professional Services Guideline for psychological services. Adjudicator Norris noted that the insurer was correct in its payment of the services within the PSG. He commented that the $224.42 per one hour session requested was not appropriate or in accordance with the PSG, while the $149.61 paid by the insurer was. The claimant also argued that the insurer was non-compliant with section 38 for delivering a late response which was “overly generic.” Adjudicator Norris agreed, noting that the denial letter was late and did not provide specific medical or other reasons for the denial. He awarded entitlement to the goods and services incurred during the period of non-compliance, staring on the 11th business day up to the day when the insurer provided a compliant notice.
