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C.M. v. Wawanesa Mutual Insurance Company (18-008199)

  • November 27, 2019

The claimant sought entitlement to attendant care benefits and a number of treatment plans for occupational therapy and physiotherapy services. Adjudicator Boyce concluded that the claimant was not entitled to attendant care as she had not demonstrated that the services were “incurred” pursuant to section 3(7)(e) of the SABS. The claimant did not provide evidence that the care was provided by a professional service provider, nor that her mother sustained an economic loss. Adjudicator Boyce also concluded that the disputed treatment plans were not reasonable and necessary, noting that aside from the OCF-18s listing her impairments and the retroactive expert reports, the claimant had provided no corroborating records from medical professionals to support the treatment sought nor the injuries claimed. Given the claimant’s failure to produce medical evidence concurrent with the accident, Adjudicator Boyce found no reason to interfere with the insurer’s determinations.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Attendant Care Benefits, Incurred Expense
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