V.K. v. Unica Insurance Inc. (18-007227)

This is a preliminary issue decision on whether the cost of assessments to determine catastrophic impairment falls within the $50,000.00 limit on medical and rehabilitation benefits. Adjudicator Ferguson concurred with previous decisions that CAT assessments are not a benefit, and found that the insurer is obliged to pay the full cost of CAT assessments subject to professional services guidelines, and with the caveat that it remains the claimant’s responsibility to show that any assessment is reasonable and necessary. Adjudicator Ferguson found that the cost of CAT assessments is not subject to the $50,000.00 limit.