Alan Wynperle

The applicant sought payment of $1,284 for an EMG assessment and report prepared by a neurophysiology expert following a motor vehicle accident.

The insurer denied the claim, arguing it was not for the purpose of the Regulation and was covered by OHIP.

The arbitrator found the assessment was for the purpose of the Regulation and that the insurer failed to prove it was covered by OHIP.

However, the arbitrator found the fee unreasonable because the report was less than useful in developing a rehabilitation plan, and reduced the payable amount to $749.

The applicant was injured in a motor vehicle accident and received statutory accident benefits.

He sought payment of $1,219.80 for a rehabilitation assessment report prepared by a social worker.

The insurer refused payment, arguing the report was not reasonable.

The arbitrator found that obtaining the report was reasonable given the applicant's ongoing impairments and the uncertainty of his return-to-work program.

However, the arbitrator concluded the cost was unreasonable because the report was superficial, vague, and lacked significant analysis.

The arbitrator reduced the payable amount to $321, representing 1.5 hours of work, plus interest.