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L.M. v Portage La Prairie Mutual Insurance Company (19-004596)

  • May 19, 2020

The claimant disputed her entitlement to attendant care benefits and various medical benefits. Adjudicator Boyce determined that the claimant was not entitled to ACBs for the period in dispute, as they are not reasonable and necessary and the claimant did not provide evidence that the services were incurred. The claimant offered no evidence or substantive submissions on whether attendant care services had been incurred, and provided no invoices, promissory notes, or affidavits speaking to services provided, the level of care, or the rate of care. Adjudicator Boyce also found that the disputed treatment plan for assistive devices was not reasonable or necessary, as the claimant provided no substantive analysis on why the specific devices were required to address his specific impairments, and it was not clear whether the claimant ever obtained any of the proposed devices which undermined his argument as to whether they were reasonable and necessary. Adjudicator Boyce did find a psychological treatment plan to be reasonable and necessary, finding enough evidence on a balance of probabilities that the claimant’s pre-existing psychological impairments were exacerbated by the accident and likely resulted in new, accident-related psychological issues that warrant treatment.

Full decision here

TGP Analysis

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  • FILED UNDER Attendant Care Benefits, Incurred Expense
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