S.M. v. Federated Insurance Company of Canada (18-004533)

The claimant sought entitlement to $6,000 per month in ACBs from April 2012 onwards, and the cost of two assessments. Adjudicator Lake considered the time period prior to and after the February 1, 2014 changes to the incurred expense definition for non-professional service providers. She held that the claimant failed to prove that her niece suffered an economic loss. No ACBs were payable beyond the 104 week mark because the claimant had not proven a catastrophic impairment. Adjudicator Lake also concluded that the two proposed assessments were not reasonable and necessary. The first was for a Form 1 after the 104 week mark, prior to the claimant submitting an OCF-19. The second was for a clinic file review as part of a catastrophic impairment assessment, which the adjudicator found to be duplicative the services conducted as part of each approved constituent element of the catastrophic impairment assessments.