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Applicant v. Certas Direct (17-002792)

  • April 28, 2018

The claimant sought entitlement to IRBs, one treatment plan, and interest. Adjudicator Msosa held that the medical evidence did not indicate the claimant had suffered a substantial inability to perform his employment as a security guard and was therefore not entitled to IRBs. The claimant argued that the treatment plan was payable as the insurer had failed to provide ten days notice, as required by section 38(11). Adjudicator Msosa found that the insurer had responded within the timelines required by the SABS, and further concluded that the claimant was not entitled to the medical benefit sought as it was not reasonable and necessary.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Medical Benefits
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