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K.P. v. Aviva General Insurance (19-001985)

  • July 24, 2020

The claimant disputed his entitlement to a treatment plan for medical cannabis, which the insurer denied based on an IE report that determined that medical cannabis was not reasonable and necessary to treat the claimant’s chronic pain. The insurer further noted that the claimant smoked marijuana daily for several years prior to the accident (and continued to do so after the accident), and argued that it was unreasonable for the claimant to ask the insurer to pay for the same amount of marijuana that he smoked previously. Nonetheless, Adjudicator Boyce held that the claimant was entitled to the cost of the treatment plan, plus interest, as it was reasonable and necessary. She preferred the recommendations of the claimant’s chronic pain specialist and cannabis clinic physician, who both believed that medical cannabis was appropriate, over the opinion of the IE assessor.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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