The claimant sought entitlement a treatment plan for $14,804.51 for medical services, which he claimed was not properly denied in accordance with section 38 of the SABS. The claimant further argued that the insurer’s denial was deficient as it referenced a different health provider than the one listed on the disputed plan, and it did not reference the amount being denied. The second denial referenced the opinions of the IE assessors, but did not include the reports on which the denial was based. The insurer argued that its medical and other reasons were clearly stated in the denial. The insurer did not make an argument with regard to the failure to deliver the IE reports within 10 business days, but noted that the IE reports were provided one month later. Adjudicator Manigat ruled that the treatment plan in dispute was not properly denied as per section 38 of the SABS, but that the insurer rectified the error when it subsequently provided the IE reports. The claimant was therefore only entitled to payment of amounts incurred during the period of non-compliance, as well as interest on any amounts incurred during that period.
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