2 total
Catastrophic impairment assessments are not medical benefits and are payable outside the medical benefit policy limit.
The applicant sought funding for a multidisciplinary assessment to determine catastrophic impairment after a motor vehicle accident.
The insurer denied the treatment plan, arguing that catastrophic impairment assessments are subject to the exhausted $65,000 medical benefit limit.
The Tribunal held that assessments for determining catastrophic impairment are not medical benefits and are therefore payable outside the medical benefit policy limit under section 25 of the Schedule.
The Tribunal ordered the insurer to pay the assessment costs up to the $2,000 limit per assessment, but denied a separate fee for clinical file review and a claim for a special award.
Motion to compel production of cell phone records dismissed for lack of relevance.
The insurer brought a motion to compel the applicant to produce her cell phone records for the date of the motor vehicle accident.
The insurer argued the records were necessary to locate a witness to clarify discrepancies regarding the circumstances of the accident.
The arbitrator dismissed the motion, finding that the insurer did not dispute that the accident occurred and made no allegation of fraud.
The cell phone records were deemed not relevant to the substantive issues in dispute, and their probative value did not outweigh the applicant's reasonable expectation of privacy.
