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Applicant v. Certas Direct Insurance Company (17-008853)

  • October 2, 2019

The claimant sought removal from the MIG, and entitlement to ACBs and various medical benefits. The insurer argued that the claimant was barred from proceeding to a hearing due to his failure to attend an IE addressing attendant care benefits. Vice Chair Helt concluded that the claimant was not barred from proceeding with his claim for ACBs because the IE notices contained the wrong address for the IE location. In terms of the claimed benefits, Vice Chair Helt found that the claimant suffered from psychological injuries falling outside of the MIG. She awarded the claimed psychological assessment and therapy, but held that the proposed physical therapy was not reasonable and necessary. Finally, in terms of the ACBs, Vice Chair Helt concluded that the claimant did not require personal care and that he had not incurred any attendant care expenses.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Minor Injury Guideline, Attendant Care Benefits, IE Non-Attendance
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