The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment.
After an initial denial by the insurer, the applicant underwent further assessments by CEMED Inc. without submitting an OCF-22 or seeking prior approval from the insurer.
The applicant subsequently applied for arbitration to recover $18,073.24 for the cost of the CEMED assessments.
The arbitrator dismissed the claim, finding that under Section 24(1.1) of the Statutory Accident Benefits Schedule, the insurer is not required to pay for an assessment if the expense is incurred before the insurer approves it.
Since the applicant failed to seek prior approval, the insurer was not liable for the costs.
