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A.W.A. v Certas Home and Auto Insurance (18-007207)

  • March 12, 2021

The claimant sought reconsideration of a LAT decision denying the $24,000 cost of catastrophic impairment assessments. Adjudicator Gosio dismissed the claimant’s request for reconsideration. Adjudicator Gosio agreed with the claimant that the hearing adjudicator failed to consider that the OCF-18 for CAT assessments concerned both Criterion 7 and 8. Adjudicator Gosio held that irrespective of this error, he would have arrived at the same finding. Adjudicator Gosio held that the claimant failed to establish a link between his chronic pain and entitlement to pre-104 week IRBs and the need for the CAT assessments. Adjudicator Gosio held that the proposed CAT assessments were not reasonable or necessary.

Full decision here

TGP Analysis

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  • FILED UNDER CAT Assessments, Reconsideration
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