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Li v. Allstate Insurance (19-004738)

  • May 25, 2021

The claimant sought entitlement to IRBs, two treatment plans for physical and psychological therapy, and a special award. Vice Chair Boyce dismissed the claims. The claimant failed to provide sufficient information proving that she was employed at the time of the accident. The Record of Employment suggested that she quit her job a few days prior to the accident. The employer told the insurer the same information. The claimant disputed that this was accurate, but failed to provide an amended Record of Employment. Further, the claimant’s impairments were not sufficiently serious to meet the “substantial inability” test. The medical records showed only sporadic complaints to the family physician. The IE reports were accepted by Vice Chair Boyce, which opined that the claimant did not suffer from a psychological or orthopaedic injury. The claimed treatment plans were also denied due to the claimant’s failure to prove that the treatment was reasonable and necessary. The claimant had reported to her family doctor that she was “basically pain free” as of August 2018.

Full decision here
Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Medical Benefits
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© 2020 Thomas Gold Pettingill LLP