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Biro v. Unica Insurance Inc. (20-003720)

  • March 4, 2021

The claimant was involved in an accident in 2007. In 2017, FSCO issued a decision granting the applicant ACBs and certain medical benefits. FSCO determined the claimant was not catastrophically impaired and denied a claim for NEBs. The claimant appealed the FSCO decision. The appeal was denied. In April 2020, the self-represented claimant applied to the LAT claiming $6 million for chiropractic services arising from the accident. Adjudicator McGee found that the LAT did not have jurisdiction to hear the application because the claimant had not filed a treatment plan as required under s. 38, and the insurer did not have the opportunity to approve or deny the benefit claimed in the LAT application. Adjudicator McGee found that without a denial of a benefit, the LAT did not have power under the Insurance Act to hear or decide on an application for benefits. The LAT application was dismissed. As the LAT did not have jurisdiction, Adjudicator McGee did not address the other grounds for dismissal raised by the insurer.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Jurisdiction
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