Matthew J. Cino

The insurer requested a reconsideration of a decision granting the insured partial payment for multidisciplinary catastrophic impairment assessments.

The insurer argued the OCF-18 was invalid because it was completed by a chiropractor recommending assessments outside her scope of practice, and that the assessments were unpayable 'rebuttal' reports.

The Adjudicator dismissed the reconsideration, finding that a chiropractor may recommend assessments by other specialists and that the reports were the insured's first set of assessments, not rebuttals.

Although a procedural error occurred regarding post-hearing submissions, it was remedied on reconsideration.

The insurer's request was dismissed, and the insured's request for costs was denied.

The applicant was injured in a motor vehicle accident in 2000 and sought funding for multidisciplinary catastrophic impairment (CAT) assessments.

The respondent insurer denied the treatment plan, arguing the assessments were not reasonable or necessary and relying on its own insurer's examinations which concluded the applicant did not meet the CAT threshold.

The Tribunal found that the applicant was entitled to explore whether she was catastrophically impaired and that the insurer's completion of its own CAT assessments supported the need for the applicant to obtain her own reports.

The Tribunal awarded $14,000 for seven of the requested assessments, as well as $400 for the completion of the OCF-18 and OCF-19 forms.

Claims for file review and psychometric testing fees were denied as duplicative.

The applicant's claim for a special award under Ontario Regulation 664 was dismissed.