J.S. v. Aviva General Insurance Company (16-002529)

The claimant sought entitlement to a treatment plan. The insurer asserted the treatment plan was not reasonable a necessary. The insurer also objected to evidence supplied by the claimant’s OT, as it was not disclosed at the case conference. Adjudicator Sandeep Johal ruled that the inclusion of more documentation on the part of the claimant did not prejudice the insurer and allowed the testimony. However, on review of the evidence, the treatment plan was physical-based and the claimant’s aliments, psychological; the plan was deemed not reasonable and necessary and not payable.