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J.R. v. Certas Home and Auto Insurance Company (16-003921)

  • February 26, 2018

The claimant sought entitlement to a number of medical benefits. The insurer denied the treatment plans based on IE reports and the LAT agreed with the denials. On reconsideration, however, Executive Chair Linda Lamoureux determined that the Tribunal arrived at the determination in a manner that was procedurally unfair to the claimant. At the Tribunal level, the claimant failed to submit the disputed treatment plans as evidence. Executive Chair Lamoureux determined that the Tribunal deciding in the absence of these documents, without asking the claimant’s counsel for the materials was a breach of procedural fairness and remitted the matter back to the Tribunal for a new determination.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Reconsideration
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