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Berardinelli v. Aviva Insurance Company, (21-007728/AABS)

  • January 5, 2023

The insurer requested that the claimant attend insurer examinations (IE) to assess her claims for various benefits. The claimant only attended one IE, and the insurer sought to bar the claimant’s application for attendant care, non-earner benefits, and treatment plans for her failure to attend IEs. The insurer sent 4 notices of examination to assess the claimant’s entitlement to NEBs, 6 notices of examination to assess the claimant’s application for attendant care, and one notice of examination to assess the claimant’s OCF-3. Adjudicator Kaur held that all of the notices of examination were defective, and the claimant’s application was allowed to proceed. All of the insurer’s notices were found to be vague, as they did not refer to the claimant’s medical condition. In all of the notices of examination, the insurer failed to specifically identify and state what injuries or impairments they believed were not caused by the accident.

Full decision here

TGP Analysis

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  • FILED UNDER IE Non-Attendance
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