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Applicant v. TD Insurance (17-003356)

  • January 26, 2018

The claimant sought entitlement to medical benefits, including a number of prescription expenses. The insurer raised a causation argument as the claimant’s medical history was littered with previous MVAs and workplace injuries. The claimant countered by noting the insurer previously approved treatment, which would suggest the insurer accepted the subject motor vehicle accident as the cause of the claimant’s impairments. Adjudicator Christopher Ferguson reviewed the medical evidence and determined the MVA was the cause of the claimant’s injuries. Since the insurer did not object to the reasonableness of medication claimed, the medication was considered payable. The treatment sought, however, was consider not payable as the claimant failed to prove the treatment was reasonable and necessary.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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