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M.D. v. Aviva General Insurance (18-006666)

  • April 22, 2020

The claimant sought entitlement to two treatment plans, the costs of two examinations, and a special award, as well as a determination as to the quantum of an approved income replacement benefit. Adjudicator Boyce accepted the claimant’s submission that she was entitled to an IRB in the amount of $297.88 per week, finding the calculation in the insurer’s report was incorrect. The difference being use of a 52 week period, or a 365 day period; 52 weeks was held to be the correct time period. Adjudicator Boyce also found the claimant entitled to the cost of a hydrotherapy treatment plan and outstanding transportation costs. He found that the treatment plan for physiotherapy was not reasonable and necessary, noting the opinion of Dr. Josefchak, that the claimant likely achieved maximal medical improvement from facility-based treatment. He also found the claimant was not entitled to a special award.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Medical Benefits
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