An Ontario tribunal has rejected a bid to treat one neuropsychological assessment as three separate services to bypass a $2,000 fee cap.
The Licence Appeal Tribunal - Automobile Accident Benefits Service dismissed an application against Allstate Insurance Company of Canada over a disputed treatment plan for psychological and neuropsychological assessment services. The applicant, injured in a car accident on July 21, 2024, sought $4,598.44 beyond the $2,000 Allstate had already approved for a treatment plan dated March 12, 2025.
Under section 25(5)(a) of the Statutory Accident Benefits Schedule, insurers are not required to pay more than $2,000 for conducting any one assessment or examination and preparing the related report. The disputed treatment plan proposed $6,000 for a psychological diagnostic investigation, a neuropsychological assessment, and a neuropsychometric examination, plus $598.44 to complete the plan itself. The applicant argued the three components were distinct, though complementary, diagnostic services, each payable up to the $2,000 cap.
Adjudicator Rachel Levitsky disagreed. She noted only one report was produced from the assessment, signed by both an assessing psychologist and a neuropsychologist, without specifying who completed which component or over how many days. There was no evidence a separate psychometrist had conducted the neuropsychometric testing, as the treatment plan had proposed. Levitsky found nothing in the report, the treatment plan, or the applicant's submissions explaining why the neuropsychometric testing was not simply a necessary part of the broader neuropsychological assessment.
On the psychological assessment component, Levitsky found the applicant had not shown it was reasonable and necessary at all. An earlier report from another psychologist, dated November 25, 2024, had already diagnosed the applicant's condition, described her functional limitations, and recommended psychological treatment - meeting the goals a further psychological assessment would have served. That psychologist had recommended a neuropsychological assessment, but not a second psychological one.
The applicant pointed to a December 11, 2024 letter in which Allstate approved a separate psychological treatment plan based on the earlier psychologist's findings, arguing this showed the assessments were reasonable. Levitsky found the letter predated the disputed treatment plan and, if anything, undercut the applicant's position by showing the diagnostic groundwork had already been done.
She also argued Allstate's own March 25, 2025 letter - requesting diagnostic reports, clinical notes, and specialist records before considering payment - implied the insurer viewed the components as separate. Levitsky read the letter differently, finding it sought documentation behind the treatment plan rather than confirmation that a second, standalone assessment was required.
Her reasoning tracked existing tribunal precedent that neuropsychometric and neuropsychological testing form one assessment, not two - and distinguished the single case the applicant cited, where a psychological assessment had separately been found necessary. Levitsky denied the $598.44 to complete the treatment plan as well, since the applicant made no submissions on it, and found no interest owing given nothing further was payable.
