Dr. Shobhan Vachhrajani

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming funding for psychological services and a catastrophic impairment assessment.

The respondent denied the claims on the basis that they were not reasonable and necessary.

The Tribunal found that the respondent provided sufficient medical reasons for its denials and complied with the notice requirements under the Schedule.

The Tribunal concluded that the applicant failed to meet his evidentiary burden to prove the treatments and assessments were reasonable and necessary, particularly given the lack of response to prior psychological treatment and the absence of evidence supporting a neurological impairment.

The application was dismissed.

The applicant was struck by a vehicle and sought funding for a multidisciplinary Catastrophic Determination Assessment.

The insurer partially approved the request but denied $8,312.81 for clinic file reviews, transportation, and a neurological assessment.

The Tribunal found that the $2,000 limit per assessment under s. 25(5)(a) of the Schedule is a total cap that includes file reviews and report preparation.

The Tribunal also found the transportation expenses fell within the 50 km deductible and that the applicant failed to prove the neurological assessment was reasonable and necessary.

The application was dismissed.