16-002858 v State Farm Insurance Company, 2017 CanLII 85692
C.A. vs. Intact Insurance Company, 2018 ONLAT 18-000579/AABS
- Each constituent assessment that makes up the multidisciplinary catastrophic impairment determination assessment must be reasonable and necessary.
- The correct test for entitlement to a catastrophic impairment determination assessment is reasonable and necessary.
- The onus is on the claimant to show, on a balance of probabilities, that she is entitled to a payment for medical benefits under the SABS. That is, the claimant is supposed to show that each assessment recommended in the Treatment Plan is reasonable and necessary.
- The claimant’s treating practitioners – such as chiropractors or family physician – are supposed to provide evidence that the claimant was catastrophically impaired.
- The anticipated duration of disability in an OCF-3 is supposed to be longer than 9-12 weeks. It is because if the anticipated duration of disability had lapsed prior to the submission of the Treatment Plan – CAT Assessment, it is NOT going to be of assistance.
- The treating psychologist is supposed to address the impairments and diagnosis in his report within his area of expertise in order to gain credibility from the automobile insurance company.
