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Liu v. Certas Direct Insurance Company (20-012975/AABS)

  • January 9, 2023

The claimant disputed entitlement to NEBs, several treatment plans, and whether her injuries fell under the MIG. Adjudicator Maedel found that the claimant’s injuries fell outside of the MIG due to psychological impairments. Despite the insurer’s arguments that the claimant’s psychological report was based entirely on subjective reporting and not on contemporaneous medical records, Adjudicator Maedel relied on the claimant’s report because the insurer did not have a report to respond to the claimant’s report. The claim for NEBs was rejected because the claimant failed to produce evidence regarding her pre-accident lifestyle to establish how she suffered a complete inability to carry on a normal life. The disputed chiropractic treatment plan was rejected because the claimant failed to produce medical evidence to support that the treatment was reasonable and necessary. Finally, Adjudicator Maedel found that the psychological assessment was reasonable and necessary based on his finding that the claimant suffered from psychological impairments.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Non-Earner Benefits, Minor Injury Guideline
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