Assessment fee reasonableness under SABS s. 24 depends on the assessment process, not the ultimate opinion's value.
The appellant was injured in a motor vehicle accident and referred by his family doctor for a functional capacity evaluation and surface electromyograph.
The insurer refused to pay the full assessment fee, and an arbitrator reduced the fee by 50% based on the perceived limited value of the resulting report.
On appeal, the Director's Delegate held that the reasonableness of an assessment expense under section 24 of the SABS should focus primarily on the process—the time, care, and expertise involved—rather than the ultimate usefulness or correctness of the opinion.
Finding the assessment process reasonable, the Delegate ordered the insurer to pay the full account.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesAug 28, 2000
