R.B. v. RSA Insurance (19-002329)

The claimant sought entitlement to four treatment plans for medical rehabilitation and cost of examinations, including a catastrophic impairment assessment and medications. The insurer denied the benefits in dispute on the basis that the claimant’s medical limits had been exhausted. Adjudicator Kaur concluded that that cost of examination for a catastrophic assessment are not subject to the medical benefits limitation. The claimant was entitled to the catastrophic impairment assessments, but the remainder of the medical benefits were denied as there was no evidence on a balance of probabilities that the expenses were reasonable or necessary.