Applicant v. Unifund Assurance Company (16-002346)

The claimant sought entitlement to three treatment plans. The insurer asserted the plans were not reasonable and necessary. Adjudicator Paul Gosio reviewed the medical evidence and concluded the treatment plans were reasonable and necessary. Although the claimant sought a special award, Adjudicator Gosio denied the claim and noted that “an insurer will not face a special award just because an arbitrator finds that the insurer got it wrong.”