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Rattan v. Aviva Insurance Company (19-006304)

  • December 11, 2020

The claimant applied to the LAT disputing his entitlement to three medical benefits and interest. The insurer argued that the doctrine of res judicata prevented the claimant from re-litigating his entitlement to two of the disputed benefits, which the LAT had dismissed in a previous decision. Adjudicator Grant agreed with the insurer that res judicata applied as entitlement to the two disputed treatment plans had been adjudicated on the merits and the claimant was attempting to re-litigate a final decision of the LAT. With respect to the third medical benefit, Adjudicator Grant dismissed the claim noting that he preferred the evidence of the IE orthopaedic surgeon to that of the claimant’s family physician with respect to whether further treatment was reasonable and necessary. Adjudicator Grant held that the family physician’s diagnosis was based solely on the claimant’s subjective reports whereas the IE orthopaedic surgeon completed a thorough physical examination and his objective findings were that the claimant did not suffer an impairment warranting further treatment.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, LAT Rules, Jurisdiction
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