<Costs of examination for $20,765.25 including $19,000.00 for catastrophic determination assessments>
Issue: “Is the claimant entitled to the costs of examination in the amount of $20,765.25 including $19,000.00 for catastrophic determination assessments, $1000.00 for transportation and $765.25 for interpretation services?”
-2. Section 45(1) provides that an insured who sustains an impairment as a result of an accident may apply to the insurer for a determination of whether the impairment is catastrophic.
-3. Section 25(5)(a) limits the cost of any one assessment or examination to $2,000.00.
The insured/claimant bears the onus of proving on a balance of probabilities that each treatment and assessment plan is reasonable and necessary.
-4. The insurance company conducted a series of s.44 insurer assessments to determine the claimant’s entitlement to a CAT designation and, based on neuropsychological, psychiatric, physiatry and occupational therapy reports which have all been produced, this insurance company determined that the claimant/insured did sustain the catastrophic impairments under criterion 7 or 8 as a result of the accident.