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D.Y. v. Aviva General Insurance Company (18-011171)

  • March 30, 2020

The claimant sought entitlement to NEBs, medical treatment, various assessments, and a special award. In addition, the claimant sought entitlement to the balance of proposed catastrophic impairment assessments, which had been proposed in the amount of $26,400.00 and approved up to $12,400.00. The claimant was found entitled to NEBs, chiropractic and physiotherapy treatment, concussion management, and various s. 25 assessments up to $2,000.00 limit. Adjudicator Conway approved a second portion of a neuropsychological assessment, but denied the claim for additional CAT assessments because they were duplicative or for review of medical records (which is included in the $2,000 limit). The claimant was found entitled to interest if the cost of treatment had been incurred. Interest was found payable from the date payment was made by the applicant until the date of payment by the insurer. A special award of 33 percent was made due to the insurer not approving medical benefits when it had sufficient evidence that the claimant suffered from chronic pain and psychological injuries.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Non-Earner Benefits, Special Award, CAT Assessments
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