The claimant sought entitlement to various medical/rehabilitation benefits, interest on the payment of overdue benefits, and a special award. In this amended decision, Adjudicator Punyarthi preferred the claimant’s evidence over the insurer’s, finding that it persuasively demonstrated the claimant was entitled to the disputed benefits. Adjudicator Punyarthi further found that the claimant was entitled to a special award since the insurer provided reasons for denial to the claimant that were not consistent with its actual reasons for denial, and failed to consider medical treatment records on file when deciding to deny the claimant’s requests for treatment. By engaging in this conduct, Adjudicator Punyarthi found that the insurer unreasonably delayed or withheld payments to the claimant; as such, the insurer was ordered to pay an award to the claimant of 50 percent of the denied benefits (and interest) at issue. Adjudicator Punyarthi noted that the insurer’s omissions were a significant breach of its obligations to the claimant and that an award at the maximum 50 percent was thus warranted.
Menu