E.M. v Coachman Insurance Company (18-012570)

The claimant sought entitlement to medical benefits for chiropractic services, psychological services, and two examinations. Adjudicator Maleki-Yazdi found that the insurer’s denials were vague and did not provide the claimant with a meaningful explanation, so the claimant was not able to make an informed decision about whether to accept or dispute the insurer’s decision. Further, the denials did not satisfy the insurer’s obligations under section 38(8). Adjudicator Maleki-Yazdi concluded that until the insurer provided proper denials, the claimant was entitled to the costs incurred for one chiropractic treatment, one psychological treatment, and a chronic pain assessment. She found the remaining treatment plans reasonable and necessary.