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Z.A. v. Certas Direct Insurance (17-003297)

  • March 12, 2018

The claimant, who was catastrophically impaired in an earlier accident, sought entitlement to NEBs and treatment plans for medical marijuana and osteopathic treatment in relation to a subsequent accident. Adjudicator Go found that the claimant was entitled to the cost of the two disputed treatment plans plus interest, but he was not entitled to NEBs. Adjudicator Go noted that the evidence relied on by the claimant in the claim for NEBs, an OCF-3 by an OT who assessed the claimant once, a two-line report by the family doctor, and the claimant’s oral testimony given at the hearing, was less persuasive than the evidence presented by the insurer, which included IE physiatry and in-home assessment reports which addressed the claimant’s pre- and post-accident activities.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Non-Earner Benefits
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