<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?” -1. Section 25(1)5 of the SABS stipulates that an insurer shall pay reasonable fees incurred by … Read More
<Denied chronic pain assessment and physiotherapy treatments Re-adjudicated and Overturned by the Insurance Company> 1. Our applicant’s office has met our onus successfully to prove that the two treatment plans for physiotherapy treatments and chronic pain assessment are reasonable and necessary. 2. Clinical notes and records from all treating doctors have been submitted as evidence … Read More
<Removal from the Minor Injury Guideline under the Schedules> 1. An insured person may be removed from the MIG if it can be established that accident-related injuries fall outside of the MIG or, under s. 18(2), that a documented pre-existing injury or condition combined with compelling medical evidence states that the condition precludes recovery if … Read More
-Section 25(1) of the Schedule says that the insurer shall pay for the reasonable fees charged for preparing an application under s. 45 for a determination of whether the insured person has sustained a catastrophic impairment, including any assessment or examination necessary for that purpose. -We have relied on several past LAT and FSCO cases … Read More
<CAT Assessment Funding> -Section 25(1) of the SABS states reasonable fees charged for preparing an application under s. 45 for a determination of whether the insured person has sustained a catastrophic impairment, including any assessment or examination necessary for that purpose. -The cost of CAT assessments do not come under the limits of s. 18 … Read More
<Insurer’s failure to give proper s.38(8) notice and s.38(11)2 remedies under the SABS> – The Insurer’s Denial Notice or EOB failed to meet the prescribed content requirements of s.38(8) because it failed to provide medical reasons for the insurer’s refusal to pay for a chronic pain assessment. The following arguments have been established successfully: i. The … Read More
<Attendant Care Benefits and s.44 Insurer Examinations> -The MVA claimant can apply for an attendant care benefit by submitting an Assessment of Attendant Care Needs (Form 1).And, the Form 1 is, in general, completed by his treating Occupational Therapist.And, the Insurance Company can exercise its right under s. 44 of the SABS to have the … Read More
<Concussion – Out of MIG under the SABS> Our Legal Services argued that our client did not suffer a minor injury, because the accident left him with a concussion. Therefore, since a concussion is a brain injury, and brain injuries fall outside of the MIG. Our Legal Services has produced the clinical notes and records of our client’s … Read More
<Calculation of the self-employment income> – $150,000.00 (gross annual employment income during the last fiscal year) – less $50,000 (loss from self-employment to be subtracted = $100,000.00 Multiply by 70% equals $70,000.00 (our client earned no post-accident income.) This amount is then divided by 52 weeks to come to a weekly income replacement benefit of … Read More
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