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D.K. v. The Guarantee Company of North America (18-007722)

  • November 25, 2019

The claimant sought entitlement to attendant care benefits in the amount of $3,022.33 per month, physical treatment proposed in three treatment plans, and the cost of various expenses related to food, prescriptions, assistive devices, and other goods. Vice Chair Lester found that the claimant was entitled to the physical treatment plans and the cost of non-prescription Tylenol. The clamant was not entitled to attendant care benefits based on a finding that the benefits were not reasonable and necessary, and there was no evidence the non-professional service providers sustained an economic loss. The decision refers to a s. 25 Form 1 but it does not indicate that a s. 44 Form 1 was completed. Vice Chair Lester found that the recommendation for $3,022.33 in attendant care services did not coincide with the test results that demonstrated the claimant had the functional ability to complete tasks. Expenses related to fibromyalgia were not payable as this was a pre-existing condition, and the claimant had not submitted medical evidence to show the condition was worsened by the accident.

Full decision here

TGP Analysis

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