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Majeed v. Aviva General Insurance Company (20-004520)

  • May 8, 2021

The claimant sought entitlement to ACBs of $1,017 per month, occupational therapy services, and assistive devices. Adjudicator Mazerolle denied the claim for ACBs. First, he held that the claimant was not entitled to claim ACBs prior to submission of the Form 1. Second, the only invoices for services pre-dated submission of the Form 1. Third, the claimant led no evidence that he had incurred the services and made no argument why the services should be deemed incurred. Adjudicator Mazerolle awarded the two disputed medical benefits. He found that the occupational therapy services would assist the claimant with his cognitive changes, and that the assistive devices would assist in reducing the claimant’s pain. However, the insurer was not required to pay for any incurred amounts until the claimant submitted signed treatment plans.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Attendant Care Benefits
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