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C.M. v. Intact Insurance Company (18-008995)

  • December 4, 2020

This is a reconsideration decision of Adjudicator Manigat. The insurer sought reconsideration of Adjudicator Manigat’s initial decision wherein she found that the claimant was entitled to the balance of a psychological treatment plan in the amount of $887.93 plus interest. The insurer submitted that the Tribunal considered the wrong issue in dispute and did not consider the issues stated in the Case Conference Report and Order. Adjudicator Manigat referred to a transcript of the hearing wherein she restated the issues in dispute and noted that the insurer did not object to these issues, despite the fact they were different than stated in the Case Conference Order. Therefore, Adjudicator Manigat held that the issues in dispute that she considered were correct, as proven by the transcript of the hearing. However, Adjudicator Manigat agreed with the insurer that she failed to consider all of the evidence before her with respect to the treatment plan. Adjudicator Manigat reviewed the evidence and agreed that the claimant failed to provide sufficient evidence that she required the balance of the disputed treatment plan. Adjudicator Manigat therefore granted the insurer’s request for reconsideration and varied the original decision.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Reconsideration
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