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Applicant v. Wawanesa Mutual Insurance Company (16-001181)

  • March 23, 2017

This is a reconsideration decision under LAT Rule 18.2(b) wherein the original decision found the claimant not entitled to claim expenses related to a trip to Disney World. Executive Chair Lamoureux noted that there were no further submissions on the part of the claimant, and it appeared the Tribunal was merely “urged to discover the error.” Although Executive Chair Lamoureux did not entirely agree with the original Adjudicator’s analysis, it was concluded that the proper interpretation of section 16 of the SABS was conducted and the same result would have occurred. Executive Chair Lamoureux interpreted section 16(3) as a provision aimed to serve a rehabilitative purpose. The trip to Disney was seen as an event meant to be enjoyed as a result of the rehabilitation process, not for, or part of, the rehabilitation of the claimant. As a result, the original decision was maintained and the expenses claimed remained denied.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Reconsideration
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