The claimant sought a special award from the insurer relating to the denial and subsequent approval of a psychological assessment prior to a LAT hearing. Adjudicator Hines determined that the insurer unreasonably withheld and delayed payment of a treatment plan for the psychological assessment. As a result, she determined that a special award of 25 percent of the treatment plan was appropriate. The Tribunal considered the length of the delay, the blameworthiness of the insurer’s conduct, the vulnerability of the insured person, the harm or potential harm directed at the insured person, the need for deterrence, and any advantage wrongfully gained by the insurer from the misconduct. The Adjudicator found the length of the delay the most aggravating factor as the insurer had denied the treatment plan without any rationale and did not approve the benefit for almost two years from the date it was submitted. Further, the Adjudicator found that the claimant was particularly vulnerable as she was a minor when the treatment plan was initially denied. An insurer ought to use extra care when handling treatment plans for minors and be clear with its rationale for denial. The Adjudicator reduced the quantum of the special award because the claimant failed to demonstrate that she had been prejudiced by the insurer’s conduct, and because the insurer approved the treatment plan eight months before the hearing.
